Dca of So Ga LLC

Primary specialty

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

Legal business name

DCA OF SO GA LLC

Practice address

3564 N Crossing Cir Ste a
Valdosta, GA 31602-6413

Phone

(229) 249-3222

Fax

(229) 249-0775

NPI assigned

Apr 7, 2006

Organization subpart

Yes

Parent organization

U S RENAL CARE INCAs reported in NPPES

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

Authorized official

Name

Mr. Thomas L Weinberg

Title

Vice President & Secretary

Phone

(214) 736-2700

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• U S Renal Care South Georgia Dialysis Doing business as

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Listed as

USRC South GeorgiaCCN 112688

Overall star rating

1.0 of 5

Ownership

Profit

Certified

Nov 21, 2000

Medicare certification status

ActiveFrom the Provider of Services file

Chain

US Renal Care, Inc.

Dialysis stations

21

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

CLIA laboratory certificates

Locations

Affiliated clinicians 2

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

• Olufemi Bunmi Aina, MBBS

  • Hospitalist Physician
  • Braselton, GA
  • NPI 1356690671

  Dialysis facility

  Care Compare affiliation Name & address match
• Arunas Urbonas, M.D.

  • Nephrology Physician
  • Valdosta, GA
  • NPI 1790771004

  Dialysis facility

  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1144368000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1405555200000",
    "number": "1790748101",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 19119",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "724036601",
            "telephone_number": "870-931-5400",
            "fax_number": "870-931-5418"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3564 N CROSSING CIR STE A",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "316026413",
            "telephone_number": "229-249-3222",
            "fax_number": "229-249-0775"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DCA OF SO GA LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "U S RENAL CARE INC",
        "enumeration_date": "2006-04-07",
        "last_updated": "2014-07-17",
        "status": "A",
        "authorized_official_last_name": "WEINBERG",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "VICE PRESIDENT & SECRETARY",
        "authorized_official_telephone_number": "214-736-2700",
        "authorized_official_name_prefix": "Mr."
    },
    "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": "000895309C",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "U S Renal Care South Georgia Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Shakierra Dawson
• Steven Brian Dawson, M.D.
• Daniel Day
• Mary T Dazey, CNM
• Dca of Central Valdosta LLC
• Ashley De Plato
• Brandon Dean, PTA
• Raymond Dean, LPC
• Deanna Folsom LCSW PC
• Deborah F McDonald OD PC

• All providers in Valdosta, GA
• 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 Jul 17, 2014; 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.