# KEN HOMOLYA MD LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1619266814
- **Authorized official:** KENNETH MICHAEL HOMOLYA MD (OWNER / PHYSICIAN)
- **Authorized official phone:** (615) 431-5484

## Contact information

- **Practice address:** 625 JOHNNY CASH BLVD STE 3, HENDERSONVILLE, TN 37075-2602
- **Practice address phone:** (615) 431-5484
- **Practice address fax:** (615) 447-5959
- **Mailing address:** 625 JOHNNY CASH BLVD STE 3, HENDERSONVILLE, TN 37075-2602
- **Mailing address phone:** (615) 431-5484
- **Mailing address fax:** (615) 447-5959

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208VP0000X | Pain Medicine Physician | 45952 | TN | Yes |

## Other

- **Enumeration date:** 03/29/2011
- **Last updated:** 12/14/2020