Healthcare Provider Details

I. General information

NPI: 1184807679
Provider Name (Legal Business Name): KENNA S. GIVEN, MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

1120 15TH ST
AUGUSTA GA
30912-0004
US

IV. Provider business mailing address

1499 WALTON WAY STE 1400
AUGUSTA GA
30901-2602
US

V. Phone/Fax

Practice location:
  • Phone: 706-721-2198
  • Fax: 706-721-5748
Mailing address:
  • Phone: 706-724-6100
  • Fax: 706-722-5187

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. KENNA GIVEN
Title or Position: FULL TIME MD
Credential: MD
Phone: 706-721-2198