DVA RENAL HEALTHCARE INC NPI 1770551905

NPI Information

NPI: 1770551905
Provider Name: DVA RENAL HEALTHCARE INC
Classification: Clinic/Center - 261QE0700X
Specialization: End-Stage Renal Disease (ESRD) Treatment
Entity Type: Organization
Doing Business As: SOUTHERN LANE DIALYSIS
Address: 1840 SOUTHERN LN
DECATUR, GA
ZIP 30033
Phone: (404) 325-8884

Map and Directions

Get Directions

NPI Details

DVA RENAL HEALTHCARE INC is an end-stage renal disease (esrd) treatment clinic center in Decatur, GA. DVA RENAL HEALTHCARE INC NPI is 1770551905. The provider is registered as an organization entity type.
The provider Is Doing Business As Southern Lane Dialysis.

The provider's business location address is:

1840 SOUTHERN LN
DECATUR, GA
ZIP 30033-033
Phone: (404) 325-8884
Fax: (404) 325-8879

The provider's authorized official is John Winstel .
The authorized official title is Chief Accounting Officer and has the following contact phone number (253) 733-4501.

The enumeration date for this NPI number is 3/14/2006 and was last updated on 4/1/2020.

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	ESRD001004	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	000622476C	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: 3/30/2025

NPI Synchronization or Removal

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.

Previous NPI

Next NPI