| NPI | 1760004360 |
|---|---|
| Doing Business As | SOUTHERN TIDE DIALYSIS |
| Entity Type | Organization |
| Authorized Contact | SAMUEL T WEY VP Licensure & Certification 615-341-6641 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QE0700X Clinic/Center, End-Stage Renal Disease (ESRD) Treatment |
| Enumeration Date | 2020-05-18 |
| Last Update Date | 2023-10-24 |