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Dva Renal Healthcare Inc

Organization Active NPI End-Stage Renal Disease (ESRD) Treatment Clinic/Center · Douglas, GA

NPI 1376511550 · NPPES record last updated Mar 12, 2025

Key facts

NPI
1376511550
Entity type
Organization (NPI type 2)
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X
License
ESRD001018 (GA)
Legal business name
DVA RENAL HEALTHCARE INC
Practice address
190 Westside Dr Ste a
Douglas, GA 31533-3534
Phone
(912) 384-3439
Fax
(912) 383-6324
NPI assigned
Mar 14, 2006
Organization subpart
No

Authorized official

Name
Samuel T. Wey
Title
VP Licensure & Certification
Phone
(615) 341-6641

Corporate family (same tax ID) 10

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

Affiliated clinicians 1

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

Medicare Care Compare: Dialysis facility

Listed as
DaVita Douglas Dialysis CCN 112535
Overall star rating
★★☆☆☆ 2.0 of 5
Ownership
Profit
Certified
Feb 13, 1985
Medicare certification status
Active (Provider of Services file)
Chain
DaVita
Dialysis stations
23

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

Laboratory certificates & supplier records

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
11D0665477Douglas Dialysis
190 Westside Drive Suite a, Douglas, GA 31533		Certificate of waiverAug 31, 2026

Medicare participation

Medicare fee-for-service enrollment
Enrolled in GA

Medicare enrollment records

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

National Provider Directory

Tax ID family
Gambro Healthcare Anahe (173 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X ESRD001018 GA Yes

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 identifiers

IdentifierTypeStateIssuer
000407932BMedicaidGA

Other names

  • Douglas Dialysis Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Mar 12, 2025.

{
    "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": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000407932B",
            "state": "GA"
        }
    ],
    "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

All providers in Douglas, GA · End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Georgia

Sources for this page

Verify at the official NPI Registry.