Healthcare Provider Details

I. General information

NPI: 1386414449
Provider Name (Legal Business Name): DIALYSIS DOCS A TENNESSEE PARTNERSHIP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2024
Last Update Date: 01/08/2024
Certification Date: 01/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 STERLING FARM DR
JACKSON TN
38305-5727
US

IV. Provider business mailing address

221 STERLING FARM DR
JACKSON TN
38305-5727
US

V. Phone/Fax

Practice location:
  • Phone: 731-668-4337
  • Fax: 731-661-0124
Mailing address:
  • Phone: 731-668-4337
  • Fax: 731-661-0124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SIOBHAN THAXTON
Title or Position: OFFICE MANAGER
Credential:
Phone: 731-668-4337