INNOVATIVE HOME DIALYSIS OF GEORGIA LLC NPI 1932522950

NPI Information

NPI: 1932522950
Provider Name: INNOVATIVE HOME DIALYSIS OF GEORGIA, LLC
Classification: Clinic/Center - 261QE0700X
Entity Type: Organization

Specialization: End-Stage Renal Disease (ESRD) Treatment

CLIA Number: 11D2073783

Address:
3753 MARIETTA HWY
SUITE 100
CANTON, GA
ZIP 30114
Phone: (770) 345-4103
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INNOVATIVE HOME DIALYSIS OF GEORGIA, LLC is an end-stage renal disease (esrd) treatment clinic center in Canton, GA. INNOVATIVE HOME DIALYSIS OF GEORGIA, LLC NPI is 1932522950. The provider is registered as an organization entity type.

The provider's business location address is:

3753 MARIETTA HWY
SUITE 100
CANTON, GA
ZIP 30114-328
Phone: (770) 345-4103

The provider's authorized official is Thomas L. Weinberg .
The authorized official title is Senior Vice President and has the following contact phone number (214) 736-2700.

The CLIA number assigned to this NPI record is 11D2073783 - end stage renal disease dialysis facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 1/27/2014 and was last updated on 1/25/2017.

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			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	003154586A	MEDICAID	GEORGIA
2	112890	MEDICARE OSCAR/CERTIFICATION	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: 5/5/2024

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