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General NPI Number Information
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NPI Number | 1346219342
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Entity Type | Organization
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Legal Business Name | MID-SOUTH NEPHROLOGY CONSULTANTS PLLC
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Dates
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Enumeration Date | 03/14/2006
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Last Update Date | 02/29/2012
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Provider Practice Location Address
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Address Line | 6490 MOUNT MORIAH ROAD EXT STE 200
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City | MEMPHIS
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State | TN
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Zip | 38115-3841
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Country | US
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Telephone | 901-565-0244
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Fax | 901-565-0616
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Provider Business Mailing Address
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Address Line | 6490 MOUNT MORIAH ROAD EXT STE 200
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City | MEMPHIS
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State | TN
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Zip | 38115-3841
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Country | US
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Telephone | 901-565-0244
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Fax | 901-565-0616
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | DOMINGA HERNANDEZ
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Credential |
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Telephone | 901-565-0244
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number |
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License Number State |
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