Healthcare Provider Details

I. General information

NPI: 1194636068
Provider Name (Legal Business Name): TOTAL KIDNEY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1136 J J CARTER RD
MAGNOLIA MS
39652-8556
US

IV. Provider business mailing address

3104 BRIARCLIFF RD NE # 29111
ATLANTA GA
30345-3443
US

V. Phone/Fax

Practice location:
  • Phone: 601-803-7733
  • Fax:
Mailing address:
  • Phone: 601-803-7733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: MALORIE HOLMES
Title or Position: MANAGER
Credential: MD
Phone: 225-610-6260