NPIMap

Organization Active NPI

Douglasville Dialysis Spa DDS

Doing business as DDS

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Douglasvile, GA
National Provider Identifier
1285066936
Registry record updated Jan 14, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
Legal business name
DOUGLASVILLE DIALYSIS SPA DDS
Doing business as
DDS
Practice address
3138 Golf Ridge Blvd
Douglasvile, GA 30135
Phone
(770) 485-1773
Fax
(770) 627-3202
NPI assigned
Aug 5, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 14, 2016

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

Authorized official

Name
Ms. Jenell Harris
Title
Facility Administrator
Phone
(678) 903-4470

Specialties & licenses 1

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

Addresses

Primary practice location

3138 Golf Ridge Blvd
Douglasvile, GA 30135

Mailing address

1380 Veterams Memorial Hwy SW
Mableton, GA 30126
Phone (770) 485-1773

Other names 1

  • DDS Doing business as

National Provider Directory

National Provider Directory

Locations

1380 Veterans Memorial Hwy SW
Mableton, GA 30126
Phone (770) 485-1773

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1375660800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1452729600000",
    "number": "1285066936",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1380 VETERAMS MEMORIAL HWY SW",
            "city": "MABLETON",
            "state": "GA",
            "postal_code": "30126",
            "telephone_number": "770-485-1773",
            "fax_number": "770-627-3202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3138 GOLF RIDGE BLVD",
            "city": "DOUGLASVILE",
            "state": "GA",
            "postal_code": "30135",
            "telephone_number": "770-485-1773",
            "fax_number": "770-627-3202"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DOUGLASVILLE DIALYSIS SPA DDS",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-08-05",
        "last_updated": "2016-01-14",
        "status": "A",
        "authorized_official_last_name": "HARRIS",
        "authorized_official_first_name": "JENELL",
        "authorized_official_title_or_position": "FACILITY ADMINISTRATOR",
        "authorized_official_telephone_number": "678-903-4470",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "GA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DDS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.