NPIMap

Organization Active NPI

Renal Treatment Centers - Mid-Atlantic, Inc.

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Griffin, GA
National Provider Identifier
1992774939
Registry record updated Apr 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
License
ESRD001211 Issued in GA
Legal business name
RENAL TREATMENT CENTERS - MID-ATLANTIC, INC.
Practice address
521 N Expressway Ste 1509
Griffin, GA 30223-2073
Phone
(770) 228-3177
Fax
(770) 229-8431
NPI assigned
Mar 14, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 11, 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 ESRD001211 GA Primary

Addresses

Primary practice location

521 N Expressway Ste 1509
Griffin, GA 30223-2073

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
000479476CMedicaidGA

Other names 1

  • Iris City Dialysis Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20030124000003 GA Part A Provider - End-Stage Renal Disease Facility (ESRD) 4587572383 Practice locations: Griffin, GA

Care Compare: Dialysis facility

Medicare Care Compare
Listed as
DaVita Iris City DialysisCCN 112711
Overall star rating
1.0 of 5
Ownership
Profit
Certified
Feb 4, 2002
Medicare certification status
ActiveFrom the Provider of Services file
Chain
DaVita
Dialysis stations
28

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
11D0994181Iris City Dialysis521 North Expressway Village, Griffin, GA 30223Certificate of waiverDec 5, 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 12

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

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": "1744329600000",
    "number": "1992774939",
    "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": "521 N EXPRESSWAY STE 1509",
            "city": "GRIFFIN",
            "state": "GA",
            "postal_code": "302232073",
            "telephone_number": "770-228-3177",
            "fax_number": "770-229-8431"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RENAL TREATMENT CENTERS - MID-ATLANTIC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-14",
        "last_updated": "2025-04-11",
        "certification_date": "2025-04-11",
        "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": "ESRD001211",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000479476C",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Iris City Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Iris City Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Griffin, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 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.