Healthcare Provider Details

I. General information

NPI: 1194722850
Provider Name (Legal Business Name): DAVID E KENT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 10/15/2020
Certification Date: 10/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 COLISEUM DR SUITE 200
MACON GA
31217-3876
US

IV. Provider business mailing address

308 COLISEUM DR SUITE 200
MACON GA
31217-3865
US

V. Phone/Fax

Practice location:
  • Phone: 478-742-2180
  • Fax: 478-745-2623
Mailing address:
  • Phone: 478-742-2180
  • Fax: 478-745-2623

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number025625
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number025625
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: