Healthcare Provider Details

I. General information

NPI: 1003258484
Provider Name (Legal Business Name): REN DERMATOLOGY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2013
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 COVEY DR SUITE 200
FRANKLIN TN
37067-5602
US

IV. Provider business mailing address

1195 OLD HICKORY BLVD STE 200
BRENTWOOD TN
37027-4239
US

V. Phone/Fax

Practice location:
  • Phone: 617-359-5366
  • Fax:
Mailing address:
  • Phone: 615-835-3220
  • Fax: 615-835-3235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMD0000046202
License Number StateTN

VIII. Authorized Official

Name: JULIANNE PIVARONAS
Title or Position: DIRECT OR PRACTICE OPERATIONS
Credential:
Phone: 615-835-3220