Medlock Bridge Dialysis LLC

Primary specialty

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

Legal business name

MEDLOCK BRIDGE DIALYSIS LLC

Doing business as

Mountainside Dialysis

Practice address

700 N Main St
Jasper, GA 30143-1404

Phone

(678) 387-1274

Fax

(678) 387-1292

NPI assigned

Apr 7, 2020

Last updated

Dec 29, 2025By the provider in NPPES

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 names 1

• Mountainside Dialysis Doing business as

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Listed as

DaVita Mountainside DialysisCCN 852584

Overall star rating

3.0 of 5

Ownership

Profit

Certified

Jan 21, 2021

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

  dba Milledgeville Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Milledgeville, GA
  • NPI 1962461152

  Member Of

  NPD member

Locations

Affiliated clinicians 3

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

• Dinesh K Bhatia, MD

  • Nephrology Physician
  • Atlanta, GA
  • NPI 1407941008

  Dialysis facility

  Care Compare affiliation Name & address match
• Ravi Dinesh Bhatia, DO

  • Nephrology Physician
  • Canton, GA
  • NPI 1508211376

  Dialysis facility

  Care Compare affiliation Name & address match
• Najam Sabreen, MD

  • Nephrology Physician
  • Canton, GA
  • NPI 1699701995

  Dialysis facility

  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1586217600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1766966400000",
    "number": "1245869619",
    "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": "700 N MAIN ST",
            "city": "JASPER",
            "state": "GA",
            "postal_code": "301431404",
            "telephone_number": "678-387-1274",
            "fax_number": "678-387-1292"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDLOCK BRIDGE DIALYSIS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-04-07",
        "last_updated": "2025-12-29",
        "certification_date": "2025-12-29",
        "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": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mountainside Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mountainside Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Abraham Mathai, M.D., PH.D.
• Matthew W Camp Ophthalmology LLC (Georgia Mountain Ophthalmology)
• Ana Amadeu McCook, PT
• Carl Dean McCurdy, M.D.
• Elizabeth Jane McKinley, FNP-C
• Janice Meeks, CRNA
• Felicia Merrell, PHD
• MG Medical Equipment and Supply LLC
• Michael King LCSW LLC
• Curtis R Miles, MD

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Jasper, GA
• Providers in Jasper, 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 Dec 29, 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.