Organization
KEN HOMOLYA MD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KENNETH MICHAEL HOMOLYA MD (OWNER / PHYSICIAN)
(615) 431-5484
Entity
Organization
Contact information
Practice address
625 JOHNNY CASH BLVD STE 3, HENDERSONVILLE, TN 37075-2602
(615) 431-5484
(615) 447-5959
Mailing address
625 JOHNNY CASH BLVD STE 3, HENDERSONVILLE, TN 37075-2602
(615) 431-5484
(615) 447-5959
Taxonomy
Speciality
Code
Description
License number
State
208VP0000X
Pain Medicine Physician
Primary
45952
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
TN
Enumeration date
03/29/2011
Last updated
12/14/2020
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