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General NPI Number Information
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NPI Number | 1174094908
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Entity Type | Organization
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Legal Business Name | MID-SOUTH MEDICAL PARTNERS LLC
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Dates
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Enumeration Date | 12/05/2018
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Last Update Date | 01/13/2020
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Provider Practice Location Address
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Address Line | 4230 HARDING PIKE STE 807
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City | NASHVILLE
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State | TN
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Zip | 37205-4900
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Country | US
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Telephone | 615-419-2042
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Fax |
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Provider Business Mailing Address
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Address Line | 4230 HARDING PIKE STE 807
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City | NASHVILLE
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State | TN
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Zip | 37205-4900
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Country | US
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Telephone | 615-419-2042
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | KENNETH HOMOLYA
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Credential | MD
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Telephone | 615-419-2042
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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