NPIMap

Organization Active NPI

Renal Life Link Inc

Doing business as Paulding Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Dallas, GA
National Provider Identifier
1073540506
Registry record updated Jul 9, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
License
ESRD001083 Issued in GA
Legal business name
RENAL LIFE LINK INC
Doing business as
Paulding Dialysis
Practice address
4019 Johns Rd
Dallas, GA 30132-3420
Phone
(770) 445-3571
Fax
(770) 445-3898
NPI assigned
Jun 28, 2006
Last updated
Jul 9, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2025

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

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X ESRD001083 GA Primary

Addresses

Primary practice location

4019 Johns Rd
Dallas, GA 30132-3420

Mailing address

5200 Virginia Way
L&C Dept
Brentwood, TN 37027-7569

Other identifiers 1

IdentifierTypeStateIssuer
000619451AMedicaidGA

Other names 1

  • Paulding Dialysis Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060914000364 GA Part A Provider - End-Stage Renal Disease Facility (ESRD) 9931162211 Practice locations: Dallas, GA

Care Compare: Dialysis facility

Medicare Care Compare
Listed as
DaVita Paulding DialysisCCN 112594
Overall star rating
2.0 of 5
Ownership
Profit
Certified
May 1, 1994
Medicare certification status
ActiveFrom the Provider of Services file
Chain
DaVita
Dialysis stations
16

Name & address match This facility record has no NPI; it was connected to this NPI by matching name and address.

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
11D0891569Paulding Dialysis4019 Johns Road, Dallas, GA 30132Certificate of waiverSep 11, 2026

National Provider Directory

National Provider Directory
Tax ID family
Renal Life Link Inc32 organizations share this tax ID, including this one

Other organizations with this tax ID 31

Organizations that report the same tax identification number in the National Provider Directory.

View all 31

Practitioners & affiliated clinicians

Affiliated clinicians 1

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

NPI Registry JSON

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

{
    "created_epoch": "1151452800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1752019200000",
    "number": "1073540506",
    "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": "4019 JOHNS RD",
            "city": "DALLAS",
            "state": "GA",
            "postal_code": "301323420",
            "telephone_number": "770-445-3571",
            "fax_number": "770-445-3898"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RENAL LIFE LINK INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-28",
        "last_updated": "2025-07-09",
        "certification_date": "2025-07-09",
        "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": "ESRD001083",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000619451A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Paulding Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Paulding Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Dallas, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 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.