National Provider Identifier Database

DIVERSIFIED RENAL GROUP LLC
Nephrology

An internist who treats disorders of the kidney, high blood pressure, fluid and mineral balance and dialysis of body wastes when the kidneys do not function. This specialist consults with surgeons about kidney transplantation.


Contact Information

DIVERSIFIED RENAL GROUP LLC
5903 RIDGEWOOD RD
STE 340
JACKSON, MS39211
Phone: 601-899-3340
Fax: 601-899-3343
Website:
Specialty Taxonomy Code
* Nephrology 207RN0300X

* Indicates primary specialty

NPI Profile & details for DIVERSIFIED RENAL GROUP LLC

NPI Number 1184792038
Legal business name
LBN
DIVERSIFIED RENAL GROUP LLC
Authorized official GARY DAVIS - (MEMBER)
Entity Organization
Organization subpart No
Enumeration date 11/30/2006
Last updated 04/25/2008 - About 18 years ago
Sole proprietor1 Not specified
Identifiers
  • MS Medicaid: 09014813

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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