SADDLEBACK DIALYSIS LLC NPI 1508175464

NPI Information

NPI: 1508175464
Provider Name: SADDLEBACK DIALYSIS LLC
Classification: Clinic/Center - 261QE0700X
Specialization: End-Stage Renal Disease (ESRD) Treatment
Entity Type: Organization
Doing Business As: MAGNOLIA OAKS DIALYSIS
CLIA Number: 11D2003617
Address: 2377 HWY 196 W
HINESVILLE, GA
ZIP 31313
Phone: (912) 368-2710

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NPI Details

SADDLEBACK DIALYSIS LLC is an end-stage renal disease (esrd) treatment clinic center in Hinesville, GA. SADDLEBACK DIALYSIS LLC NPI is 1508175464. The provider is registered as an organization entity type.
The provider Is Doing Business As Magnolia Oaks Dialysis.

The provider's business location address is:

2377 HWY 196 W
HINESVILLE, GA
ZIP 31313-036
Phone: (912) 368-2710
Fax: (912) 368-2714

The provider's authorized official is Samuel Wey .
The authorized official title is Sr Director Licensure&certification and has the following contact phone number (615) 341-6641.

The CLIA number assigned to this NPI record is 11D2003617 - end stage renal disease dialysis facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 9/27/2010 and was last updated on 9/6/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QE0700X	Clinic/Center	End-Stage Renal Disease (ESRD) Treatment	ESRD000739	GEORGIA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	11D2003617	OTHER	GEORGIA	CLIA
2	003101245A	MEDICAID	GEORGIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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