Healthcare Provider Details

I. General information

NPI: 1881745842
Provider Name (Legal Business Name): KENT E KRONOWSKI DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 06/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1519 LANEY WALKER BLVD
AUGUSTA GA
30904-5827
US

IV. Provider business mailing address

1515 LANEY WALKER BLVD
AUGUSTA GA
30904-5827
US

V. Phone/Fax

Practice location:
  • Phone: 706-724-1224
  • Fax: 706-722-3338
Mailing address:
  • Phone: 706-724-0586
  • Fax: 706-724-4468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberGA526
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code213ER0200X
TaxonomyRadiology Podiatrist
License NumberGA526
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License NumberGA526
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberGA526
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: