ODIORNE DIALYSIS LLC NPI 1942672423

NPI Information

NPI: 1942672423
Provider Name: ODIORNE DIALYSIS LLC

Doing Business As: CHAPEL WOODS DIALYSIS

Classification: Clinic/Center - 261QE0700X
Entity Type: Organization

Specialization: End-Stage Renal Disease (ESRD) Treatment

Address:
2460 WESLEY CHAPEL RD
STE 25D
DECATUR, GA
ZIP 30035
Phone: (770) 987-1439
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ODIORNE DIALYSIS LLC is an end-stage renal disease (esrd) treatment clinic center in Decatur, GA. ODIORNE DIALYSIS LLC NPI is 1942672423. The provider is registered as an organization entity type.
The provider Is Doing Business As Chapel Woods Dialysis.

The provider's business location address is:

2460 WESLEY CHAPEL RD
STE 25D
DECATUR, GA
ZIP 30035-420
Phone: (770) 987-1439
Fax: (678) 418-7948

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

The CLIA number assigned to this NPI record is 11D2107682 - end stage renal disease dialysis facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 10/23/2015 and was last updated on 12/21/2023.

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			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	003179683A	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: 4/28/2024

NPI Synchronization or Removal

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