Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of October 4, 2026.

Northside Dialysis Center of Wake Forest University

Organization End-Stage Renal Disease (ESRD) Treatment Clinic/Center · NPI 1114904133

Northside Dialysis Center of Wake Forest University provides End-Stage Renal Disease (ESRD) Treatment Clinic/Center services in Winston Salem, North Carolina. Licensed in North Carolina. Registered with an NPI since 2005.

Licensed in
NC
In the registry since
2005

Practice location Address checks out

500 W Hanes Mill Rd
Winston Salem, NC 27105-9814
Phone: (336) 744-0577
Fax: (336) 744-9021
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

End-Stage Renal Disease (ESRD) Treatment Clinic/Center (primary) Taxonomy 261QE0700X (NC)

Record details

NPI number1114904133
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Kimberly Johnson — Credentialing Coord. · (229) 387-3528
Other names Northside Dialysis Center
NPI enumeratedDecember 30, 2005
Last updated in NPPESFebruary 9, 2026
Certification dateFebruary 9, 2026
Mailing addressPo Box 7350, Tifton, GA 31793-7350

Clinicians affiliated with this facility

Clinicians the CMS Facility Affiliation file lists at this facility.

Other providers in Winston Salem