NPIMap

Organization Active NPI

Dva Renal Healthcare Inc

Doing business as Douglas Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Douglas, GA
National Provider Identifier
1376511550
Registry record updated Mar 12, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
License
ESRD001018 Issued in GA
Legal business name
DVA RENAL HEALTHCARE INC
Doing business as
Douglas Dialysis
Practice address
190 Westside Dr Ste a
Douglas, GA 31533-3534
Phone
(912) 384-3439
Fax
(912) 383-6324
NPI assigned
Mar 14, 2006
Last updated
Mar 12, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 12, 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 ESRD001018 GA Primary

Addresses

Primary practice location

190 Westside Dr Ste a
Douglas, GA 31533-3534

Mailing address

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

Other names 1

  • Douglas Dialysis Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20030321000017 GA Part A Provider - End-Stage Renal Disease Facility (ESRD) 0840107611 Practice locations: Douglas, GA

Care Compare: Dialysis facility

Medicare Care Compare
Listed as
DaVita Douglas DialysisCCN 112535
Overall star rating
2.0 of 5
Ownership
Profit
Certified
Feb 13, 1985
Medicare certification status
ActiveFrom the Provider of Services file
Chain
DaVita
Dialysis stations
23

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
11D0665477Douglas Dialysis190 Westside Drive Suite a, Douglas, GA 31533Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory
Tax ID family
Gambro Healthcare Hunti173 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 10

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

Locations

190 Westside Dr
Ste A
Douglas, GA 31533
Phone (912) 384-3439

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": "1142294400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1741737600000",
    "number": "1376511550",
    "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": "190 WESTSIDE DR STE A",
            "city": "DOUGLAS",
            "state": "GA",
            "postal_code": "315333534",
            "telephone_number": "912-384-3439",
            "fax_number": "912-383-6324"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DVA RENAL HEALTHCARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-14",
        "last_updated": "2025-03-12",
        "certification_date": "2025-03-12",
        "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": "ESRD001018",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Douglas Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Douglas Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Douglas, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 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.