Healthcare Provider Details

I. General information

NPI: 1841282779
Provider Name (Legal Business Name): KEVIN RYAN RHODY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/17/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 N CONGRESS BLVD
SMITHVILLE TN
37166-2704
US

IV. Provider business mailing address

302 N CONGRESS BLVD
SMITHVILLE TN
37166-2704
US

V. Phone/Fax

Practice location:
  • Phone: 615-597-4395
  • Fax: 615-597-5075
Mailing address:
  • Phone: 615-597-4395
  • Fax: 615-597-5075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD0000035221
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: