Havenwood Dialysis LLC

Primary specialty

End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X

Legal business name

HAVENWOOD DIALYSIS LLC

Practice address

2301 Newnan Crossing Blvd
Ste 180
Newnan, GA 30265-2576

Phone

(770) 253-2403

Fax

(770) 253-8092

NPI assigned

Mar 28, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Samuel T Wey

Title

VP Licensure & Certification

Phone

(615) 341-6641

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Poplar Dialysis Doing business as

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Listed as

DaVita Poplar DialysisCCN 852560

Overall star rating

2.0 of 5

Ownership

Profit

Certified

Apr 18, 2019

Medicare certification status

ActiveFrom the Provider of Services file

Chain

DaVita

Dialysis stations

13

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

• Hypertension and Kidney Center LLC

  • Nephrology Physician
  • Atlanta, GA
  • NPI 1194060483

  Member Of

  NPD member
• Renal Treatment Centers Mid Atlantic Inc

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Goldsboro, NC
  • NPI 1174086698

  Member Of

  NPD member

Locations

Networks

• SC HMO

Affiliated clinicians 5

Clinicians who list this facility as an affiliation in Medicare Care Compare.

• Shazia Khan, MD

  • Nephrology Physician
  • Newnan, GA
  • NPI 1164526323

  Dialysis facility

  Care Compare affiliation Name & address match
• Dhruv Kamleshkumar Modi, MD

  • Internal Medicine Physician
  • Fayetteville, GA
  • NPI 1891185815

  Dialysis facility

  Care Compare affiliation Name & address match
• Vishal N Ratkalkar, M.D.

  • Nephrology Physician
  • Newnan, GA
  • NPI 1932189503

  Dialysis facility

  Care Compare affiliation Name & address match
• Sushma Reddycherla, MD

  • Nephrology Physician
  • Fayetteville, GA
  • NPI 1659626349

  Dialysis facility

  Care Compare affiliation Name & address match
• Michelle Anne Sylvina Thomas, MD

  • Nephrology Physician
  • Newnan, GA
  • NPI 1285155820

  Dialysis facility

  Care Compare affiliation Name & address match

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1522195200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1773187200000",
    "number": "1003311341",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 VIRGINIA WAY",
            "address_2": "L&C DEPT",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370277569"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2301 NEWNAN CROSSING BLVD",
            "address_2": "STE 180",
            "city": "NEWNAN",
            "state": "GA",
            "postal_code": "302652576",
            "telephone_number": "770-253-2403",
            "fax_number": "770-253-8092"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HAVENWOOD DIALYSIS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-28",
        "last_updated": "2026-03-11",
        "certification_date": "2026-03-11",
        "status": "A",
        "authorized_official_last_name": "WEY",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "VP LICENSURE & CERTIFICATION",
        "authorized_official_telephone_number": "615-341-6641"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "GA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003221969A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Poplar Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Poplar Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Joshua Hartsell, PHARM D
• Cheyenne Harvey, RBT
• David T Harvey, MD
• Tina Harvey, LPC
• Brannan Howard Hatfield, MD
• Heather Lynn Hawkins, M.A., L.P.C.
• April Nichole Hayes, RDH
• Ramey Hayes, CRNA
• Rebecca Hayes, RBT
• Crystal Lynn Haynes, FNP

• All providers in Newnan, GA
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.