NPIMap

Organization Active NPI

Renal Treatment Centers Mid Atlantic Inc

Doing business as Forest Park Dialysis Center

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Forest Park, GA
National Provider Identifier
1760451678
Registry record updated Oct 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
License
ESRD001186 Issued in GA
Legal business name
RENAL TREATMENT CENTERS MID ATLANTIC INC
Doing business as
Forest Park Dialysis Center
Practice address
380 Forest Pkwy Ste C
Forest Park, GA 30297-2107
Phone
(404) 361-0646
Fax
(404) 361-0727
NPI assigned
Mar 14, 2006
Last updated
Oct 21, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 21, 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 ESRD001186 GA Primary

Addresses

Primary practice location

380 Forest Pkwy Ste C
Forest Park, GA 30297-2107

Mailing address

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

Other identifiers 2

IdentifierTypeStateIssuer
000905374AMedicaidGA
1791628MedicaidLA

Other names 1

  • Forest Park Dialysis Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070827000681 DE Part A Provider - End-Stage Renal Disease Facility (ESRD) 4587572383 Practice locations: Forest Park, GA

Care Compare: Dialysis facility

Medicare Care Compare
Listed as
DaVita Forest Park Dialysis CenterCCN 112692
Overall star rating
1.0 of 5
Ownership
Profit
Certified
May 11, 2001
Medicare certification status
ActiveFrom the Provider of Services file
Chain
DaVita
Dialysis stations
18

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
11D0983603Forest Park Dialysis Center380 Forest Parkway, Forest Park, GA 30297Certificate of waiverFeb 26, 2027

National Provider Directory

National Provider Directory
Tax ID family
Renal Treatment Centers - Mid-Atlantic Inc80 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 19

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

View all 19

Locations

380 Forest Pkwy
Ste C
Forest Park, GA 30297
Phone (404) 361-0646

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": "1761004800000",
    "number": "1760451678",
    "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": "380 FOREST PKWY STE C",
            "city": "FOREST PARK",
            "state": "GA",
            "postal_code": "302972107",
            "telephone_number": "404-361-0646",
            "fax_number": "404-361-0727"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RENAL TREATMENT CENTERS MID ATLANTIC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-14",
        "last_updated": "2025-10-21",
        "certification_date": "2025-10-21",
        "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": "ESRD001186",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000905374A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1791628",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Forest Park Dialysis Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Forest Park, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 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.