Healthcare Provider Details

I. General information

NPI: 1821207911
Provider Name (Legal Business Name): DYERSBURG KIDNEY CLINIC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 MURRAY GUARD DRIVE
JACKSON TN
38305
US

IV. Provider business mailing address

640C HWY 51 BYPASS
DYERSBURG TN
38024
US

V. Phone/Fax

Practice location:
  • Phone: 731-668-4284
  • Fax:
Mailing address:
  • Phone: 731-668-6907
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code281P00000X
TaxonomyChronic Disease Hospital
License Number
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License NumberMD00000124
License Number StateTN

VIII. Authorized Official

Name: DR. KANDALA RAM CHARY
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 731-668-6907