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General NPI Number Information
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NPI Number | 1619266814
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Entity Type | Organization
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Legal Business Name | KEN HOMOLYA MD LLC
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Dates
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Enumeration Date | 03/29/2011
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Last Update Date | 12/14/2020
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Provider Practice Location Address
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Address Line | 625 JOHNNY CASH BLVD STE 3
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City | HENDERSONVILLE
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State | TN
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Zip | 37075-2602
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Country | US
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Telephone | 615-431-5484
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Fax | 615-447-5959
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Provider Business Mailing Address
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Address Line | 625 JOHNNY CASH BLVD STE 3
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City | HENDERSONVILLE
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State | TN
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Zip | 37075-2602
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Country | US
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Telephone | 615-431-5484
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Fax | 615-447-5959
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Authorized Official
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Title or Position | OWNER / PHYSICIAN
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Name | KENNETH MICHAEL HOMOLYA
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Credential | MD
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Telephone | 615-431-5484
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number | 45952
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License Number State | TN
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