Healthcare Provider Details

I. General information

NPI: 1982232237
Provider Name (Legal Business Name): BRIAN PATRICK KINEALY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2020
Last Update Date: 10/10/2026
Certification Date: 10/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 PEACHTREE ST NW STE 200
ATLANTA GA
30309-2440
US

IV. Provider business mailing address

1720 PEACHTREE ST NW STE 200
ATLANTA GA
30309-2440
US

V. Phone/Fax

Practice location:
  • Phone: 404-351-5045
  • Fax: 404-355-0691
Mailing address:
  • Phone: 404-351-5045
  • Fax: 404-355-0691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number112896
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: