Vancile Dialysis LLC

Primary specialty

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

Legal business name

VANCILE DIALYSIS LLC

Practice address

3170 Peachtree Industrial Blvd Ste 100
Duluth, GA 30097-8615

Phone

(770) 232-5219

Fax

(770) 476-3730

NPI assigned

Feb 19, 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

• Duluth Dialysis Doing business as

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Listed as

DaVita Duluth DialysisCCN 852551

Overall star rating

3.0 of 5

Ownership

Profit

Certified

Sep 5, 2018

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.

• Renal Treatment Centers Mid Atlantic Inc

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

  Member Of

  NPD member

Affiliated clinicians 1

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

• Khaled Nass, M.D.

  • Nephrology Physician
  • Gainesville, GA
  • NPI 1861495830

  Dialysis facility

  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1518998400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1751846400000",
    "number": "1124528831",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 VIRGINIA WAY",
            "address_2": "L & C DEPARTMENT",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370277569"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3170 PEACHTREE INDUSTRIAL BLVD STE 100",
            "city": "DULUTH",
            "state": "GA",
            "postal_code": "300978615",
            "telephone_number": "770-232-5219",
            "fax_number": "770-476-3730"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VANCILE DIALYSIS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-02-19",
        "last_updated": "2025-07-07",
        "certification_date": "2025-07-07",
        "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": "003212349A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Duluth Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Valencia C Ayers
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• Rachel Mae Vankempen
• Sandra Lucia Vargas, D.M.D.
• Varinder K. Singh MD PC
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• Daniela Vasquez

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Duluth, GA
• Providers in Duluth, 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 Jul 7, 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.