Healthcare Provider Details

I. General information

NPI: 1316449903
Provider Name (Legal Business Name): KEN HOMOLYA MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2018
Last Update Date: 02/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4230 HARDING PIKE STE 807
NASHVILLE TN
37205-4900
US

IV. Provider business mailing address

103 HAZEL PATH STE 7
HENDERSONVILLE TN
37075-3893
US

V. Phone/Fax

Practice location:
  • Phone: 615-846-9970
  • Fax: 615-777-3393
Mailing address:
  • Phone: 615-431-5484
  • Fax: 615-447-5959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: KENNETH MICHAEL HOMOLYA
Title or Position: OWNER
Credential:
Phone: 615-431-5484