DIVERSIFIED RENAL GROUP LLC NPI 1184792038

NPI Information

  • NPI: 1184792038
  • Provider Name: DIVERSIFIED RENAL GROUP LLC
  • Classification: Internal Medicine - 207RN0300X
  • Specialization: Nephrology
  • Entity Type: Organization
  • Address: 5903 RIDGEWOOD RD
    STE 340
    JACKSON, MS
    ZIP 39211
  • Phone: (601) 899-3340

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NPI Details

DIVERSIFIED RENAL GROUP LLC is a nephrology internal medicine in Jackson, MS. The provider is 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. DIVERSIFIED RENAL GROUP LLC NPI is 1184792038. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

5903 RIDGEWOOD RD
STE 340
JACKSON, MS
ZIP 39211
Phone: (601) 899-3340
Fax: (601) 899-3343

The provider's authorized official is Gary M Davis .
The authorized official title is Member and has the following contact phone number (601) 899-3340.

The enumeration date for this NPI number is 11/30/2006 and was last updated on 4/25/2008.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207RN0300XInternal MedicineNephrologyYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
109014813MEDICAIDMISSISSIPPI
2C02385MEDICARE PINMISSISSIPPI

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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