Dialysis of North Atlanta LLC

Primary specialty

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

License

ESRD001205 Issued in GA

Legal business name

DIALYSIS OF NORTH ATLANTA LLC

Practice address

449 Industrial Blvd Ste 240
Ellijay, GA 30540-6724

Phone

(706) 719-5354

Fax

(706) 719-5355

NPI assigned

Mar 14, 2006

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

Sr Director, Licensure & Certificat

Phone

(615) 341-6641

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Ellijay Dialysis Doing business as

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

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

{
    "created_epoch": "1142294400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696204800000",
    "number": "1689643595",
    "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",
            "telephone_number": "615-320-4268",
            "fax_number": "877-238-0567"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "449 INDUSTRIAL BLVD STE 240",
            "city": "ELLIJAY",
            "state": "GA",
            "postal_code": "305406724",
            "telephone_number": "706-719-5354",
            "fax_number": "706-719-5355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIALYSIS OF NORTH ATLANTA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-14",
        "last_updated": "2023-10-02",
        "certification_date": "2023-10-02",
        "status": "A",
        "authorized_official_last_name": "WEY",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "SR DIRECTOR, LICENSURE & CERTIFICAT",
        "authorized_official_telephone_number": "615-341-6641"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "GA",
            "license": "ESRD001205",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000973134A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ellijay Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Ellijay Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Elizabeth Cruz Landaverde, BCBA
• Danielle A D'Addamio IX, PT
• Rebecca Vinson D'Angelo, OT
• Jill Lorren Darling, D.C.
• Maggie Louise Dear, PA
• Dietary Apothecary Inc.
• Michael R Doucette Jr., LDO
• Draneco Inc
• Bradleigh Dyer-McPherson, FNP
• Ellijay Center for Change, PC

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Ellijay, GA
• Providers in Ellijay, 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 Oct 2, 2023; 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.