Provider Demographics
NPI:1518303692
Name:SOUTHERN KIDNEY SPECIALISTS, PLC
Entity Type:Organization
Organization Name:SOUTHERN KIDNEY SPECIALISTS, PLC
Other - Org Name:FRANKLIN KIDNEY CLINIC PLLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:LUNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:331-200-7761
Mailing Address - Street 1:2201 MURPHY AVENUE
Mailing Address - Street 2:SUITE 303
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203
Mailing Address - Country:US
Mailing Address - Phone:615-628-8064
Mailing Address - Fax:877-297-3060
Practice Address - Street 1:2201 MURPHY AVENUE
Practice Address - Street 2:SUITE 303
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203
Practice Address - Country:US
Practice Address - Phone:615-628-8064
Practice Address - Fax:877-297-3060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-16
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN47333207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1531698Medicaid
1518303692OtherGROUP NPI
1518303692OtherGROUP NPI