NPIMap

Organization Active NPI

Renal Treatment Centers Mid Atlantic Inc

Doing business as Northlake Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Tucker, GA
National Provider Identifier
1952379133
Registry record updated Jul 14, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
License
ESRD001189 Issued in GA
Legal business name
RENAL TREATMENT CENTERS MID ATLANTIC INC
Doing business as
Northlake Dialysis
Practice address
1350 Montreal Rd Ste 200
Tucker, GA 30084-8144
Phone
(678) 406-0825
Fax
(678) 406-0830
NPI assigned
Mar 14, 2006
Last updated
Jul 14, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 14, 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 ESRD001189 GA Primary

Addresses

Primary practice location

1350 Montreal Rd Ste 200
Tucker, GA 30084-8144

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
000479476MMedicaidGA

Other names 1

  • Northlake Dialysis Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050111000017 GA Part A Provider - End-Stage Renal Disease Facility (ESRD) 4587572383 Practice locations: Tucker, GA

Care Compare: Dialysis facility

Medicare Care Compare
Listed as
DaVita Northlake DialysisCCN 112695
Overall star rating
3.0 of 5
Ownership
Profit
Certified
Jul 12, 2001
Medicare certification status
ActiveFrom the Provider of Services file
Chain
DaVita
Dialysis stations
20

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
11D1003940Northlake Dialysis1350 Montreal Road Suite 200, Tucker, GA 30084Certificate of waiverSep 15, 2026

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 14

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

View all 14

Locations

1350 Montreal Rd
Ste 200
Tucker, GA 30084
Phone (678) 406-0825

Practitioners & affiliated clinicians

Affiliated clinicians 4

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": "1752451200000",
    "number": "1952379133",
    "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": "1350 MONTREAL RD STE 200",
            "city": "TUCKER",
            "state": "GA",
            "postal_code": "300848144",
            "telephone_number": "678-406-0825",
            "fax_number": "678-406-0830"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RENAL TREATMENT CENTERS MID ATLANTIC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-14",
        "last_updated": "2025-07-14",
        "certification_date": "2025-07-14",
        "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": "ESRD001189",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000479476M",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Northlake Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Northlake Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tucker, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 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.