Healthcare Provider Details

I. General information

NPI: 1174687404
Provider Name (Legal Business Name): MAX KUO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 13TH AVE STE 107
ALBANY GA
31701-1333
US

IV. Provider business mailing address

2300 W DOUBLEGATE DR
ALBANY GA
31721-9203
US

V. Phone/Fax

Practice location:
  • Phone: 229-883-4749
  • Fax: 229-883-3910
Mailing address:
  • Phone: 229-883-4749
  • Fax: 229-883-3910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number19713
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: