Provider Demographics
NPI:1548302789
Name:HOMOLYA, KENNETH MICHAEL JR (MD)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:MICHAEL
Last Name:HOMOLYA
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:625 JOHNNY CASH BLVD
Mailing Address - Street 2:STE 3
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-2602
Mailing Address - Country:US
Mailing Address - Phone:615-431-5484
Mailing Address - Fax:615-447-5959
Practice Address - Street 1:330 FRANKLIN RD
Practice Address - Street 2:SUITE 135A #295
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-3280
Practice Address - Country:US
Practice Address - Phone:615-431-5484
Practice Address - Fax:615-447-5959
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2020-10-19
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Provider Licenses
StateLicense IDTaxonomies
TN45952207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1548302789Medicare NSC