Organization
NEPHROLOGY SERVICES MEDICAL GROUP OF MEMPHIS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BOBBY J. KELLEY M.D. (PRESIDENT)
(901) 747-3501
Entity
Organization
Contact information
Practice address
6025 WALNUT GROVE RD STE 314, MEMPHIS, TN 38120-2123
(901) 747-3501
(901) 747-3516
Mailing address
6025 WALNUT GROVE RD STE 314, MEMPHIS, TN 38120-2123
(901) 747-3501
(901) 747-3516
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09015986
—
MS
01
—
4008478
BLUE CROSS
TN
Enumeration date
08/05/2006
Last updated
05/02/2018
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