Healthcare Provider Details

I. General information

NPI: 1619015971
Provider Name (Legal Business Name): KENNETH G MURPHY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 11/26/2024
Certification Date: 11/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3450 ACWORTH DUE WEST RD NW STE 200
KENNESAW GA
30144-1078
US

IV. Provider business mailing address

721 PARKSIDE TRL NW
MARIETTA GA
30064-4714
US

V. Phone/Fax

Practice location:
  • Phone: 770-794-6643
  • Fax:
Mailing address:
  • Phone: 770-419-1680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number035484
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number035484
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number035484
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number035484
License Number StateGA
# 5
Primary TaxonomyN
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License Number035484
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: