Mountain Park Dialysis Center, LLC

Primary specialty

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

Legal business name

MOUNTAIN PARK DIALYSIS CENTER, LLC

Doing business as

Sandy Plains Dialysis

Practice address

2550 Sandy Plains Rd Ste 160
Marietta, GA 30066-7210

Phone

(770) 509-1065

Fax

(770) 509-9912

NPI assigned

May 8, 2019

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

• Sandy Plains Dialysis Doing business as

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Listed as

DaVita Sandy Plains DialysisCCN 852570

Overall star rating

3.0 of 5

Ownership

Profit

Certified

Feb 18, 2020

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 1

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

• Total Renal Care Inc

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Rockfrd, IL
  • NPI 1154997591

  Member Of

  NPD member

Locations

Affiliated clinicians 3

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

• Charmaine I. Emelife, MD

  • Nephrology Physician
  • East Point, GA
  • NPI 1811987209

  Dialysis facility

  Care Compare affiliation Name & address match
• Muhammad Rashid Ishaque, M.D.

  • Nephrology Physician
  • Cartersville, GA
  • NPI 1255528949

  Dialysis facility

  Care Compare affiliation Name & address match
• Srijita Kumar, M.D.

  • Nephrology Physician
  • Atlanta, GA
  • NPI 1437449741

  Dialysis facility

  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1557273600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1758067200000",
    "number": "1053976613",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 VIRGINIA WAY",
            "address_2": "ATT: 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": "2550 SANDY PLAINS RD STE 160",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300667210",
            "telephone_number": "770-509-1065",
            "fax_number": "770-509-9912"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAIN PARK DIALYSIS CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-08",
        "last_updated": "2025-09-17",
        "certification_date": "2025-09-17",
        "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": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003231664A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sandy Plains Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Sandy Plains Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Ananth Mothukuri, M.D
• Nabil Michael Motlagh, DPT, PT
• George Omar Moujaes, MA
• Kierra Jahnae Moultrie, MSW
• William Brackett Moultrie
• Mountain View Oral Surgery & Dental Implants LLC
• Mountains Women'S Center LLC
• Stephanie Moyal, LCSW
• Joseph H Moyers, MD
• MRM Medical Group

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Marietta, GA
• Providers in Marietta, GA by specialty
• 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 Sep 17, 2025; 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.