Dva Renal Healthcare Inc

Primary specialty

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

License

ESRD001165 Issued in GA

Legal business name

DVA RENAL HEALTHCARE INC

Doing business as

Cedartown Dialysis

Practice address

325 West Ave
Cedartown, GA 30125-3439

Phone

(770) 748-1398

Fax

(770) 749-0755

NPI assigned

Mar 14, 2006

Last updated

Dec 9, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

James K Hilger

Title

Chief Accounting Officer

Phone

(253) 733-4500

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Cedartown Dialysis Doing business as

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Dva Renal Healthcare Inc

  dba Florissant Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Saint Louis, MO
  • NPI 1740241454

  Member Of

  NPD member

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

{
    "created_epoch": "1142294400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1418083200000",
    "number": "1700855749",
    "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": "615-320-4286",
            "fax_number": "866-594-2893"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "325 WEST AVE",
            "city": "CEDARTOWN",
            "state": "GA",
            "postal_code": "301253439",
            "telephone_number": "770-748-1398",
            "fax_number": "770-749-0755"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DVA RENAL HEALTHCARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-14",
        "last_updated": "2014-12-09",
        "status": "A",
        "authorized_official_last_name": "HILGER",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "CHIEF ACCOUNTING OFFICER",
        "authorized_official_telephone_number": "253-733-4500"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "GA",
            "license": "ESRD001165",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000859658A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cedartown Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Angela Davis
• Leslie Deems, RN
• Deanna Ruth Dennis, LPC
• Kendall Dostart, RN, BSN
• Richard Joseph Dowling, M.D.
• Amanda B Dworkin, AT
• Karen Ann Eberhart, MD
• Carol P. Edwards, D.D.S.
• Gerson Escondo, M.D.
• Veronica Escutia, RN

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Cedartown, GA
• Providers in Cedartown, 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 9, 2014; 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.