Fillmore Dialysis, LLC

Primary specialty

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

Legal business name

FILLMORE DIALYSIS, LLC

Practice address

4555 Atlanta Hwy Ste M
Loganville, GA 30052-2646

Phone

(770) 466-2582

Fax

(770) 466-3062

NPI assigned

Oct 31, 2019

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

• Grayson Dialysis Doing business as

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Listed as

DaVita Grayson DialysisCCN 852572

Overall star rating

3.0 of 5

Ownership

Profit

Certified

May 20, 2020

Medicare certification status

ActiveFrom the Provider of Services file

Chain

DaVita

Dialysis stations

17

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

Locations

Affiliated clinicians 2

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

• Kimathi Sipho Ricardo Blackwood, M.D.

  • Nephrology Physician
  • Macon, GA
  • NPI 1609071448

  Dialysis facility

  Care Compare affiliation Name & address match
• Abhinandan Reddy Pakanati, M.D

  • Nephrology Physician
  • Snellville, GA
  • NPI 1710256912

  Dialysis facility

  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1572480000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1766448000000",
    "number": "1659915882",
    "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": "4555 ATLANTA HWY STE M",
            "city": "LOGANVILLE",
            "state": "GA",
            "postal_code": "300522646",
            "telephone_number": "770-466-2582",
            "fax_number": "770-466-3062"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FILLMORE DIALYSIS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-10-31",
        "last_updated": "2025-12-23",
        "certification_date": "2025-12-23",
        "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": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003234223A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Grayson Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Grayson Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Shantaye T Felton
• Kyle E Fenton, PT, DPT
• Belinda English Few, SPEECH LANGUAGE PATH
• David Albert Fields, MD
• Pelesia A Fields, CCC/SLP
• Patricia S Finkenhoefer, NP
• Francisco Thor Fiol, PA-C
• Flamingo Nursing Services Inc
• Leland Seth Fleming, ATC
• Shelley Flemming, DOT

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Loganville, GA
• Providers in Loganville, 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 23, 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.