Healthcare Provider Details

I. General information

NPI: 1942458740
Provider Name (Legal Business Name): KENNA S GIVEN, MD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2008
Last Update Date: 09/29/2016
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 SUITE 1400
AUGUSTA GA
30901-2602
US

V. Phone/Fax

Practice location:
  • Phone: 706-721-6945
  • Fax:
Mailing address:
  • Phone: 706-724-6100
  • Fax: 706-722-5187

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number013847
License Number StateGA

VIII. Authorized Official

Name: KENNA S. GIVEN
Title or Position: CEO
Credential:
Phone: 706-446-5978