Provider Demographics
NPI:1821291543
Name:WEST TENNESSEE KIDNEY SPECIALISTS P.C.
Entity Type:Organization
Organization Name:WEST TENNESSEE KIDNEY SPECIALISTS P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED AGENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KANDALA
Authorized Official - Middle Name:R
Authorized Official - Last Name:CHARY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:731-668-4337
Mailing Address - Street 1:221 STERLING FARMS DRIVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-3609
Mailing Address - Country:US
Mailing Address - Phone:731-668-4337
Mailing Address - Fax:731-661-0124
Practice Address - Street 1:221 STERLING FARMS DRIVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-3609
Practice Address - Country:US
Practice Address - Phone:731-668-4337
Practice Address - Fax:731-661-0124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-08
Last Update Date:2009-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty