Healthcare Provider Details

I. General information

NPI: 1699721662
Provider Name (Legal Business Name): KENNESTONE HEART PHYSICIANS GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 04/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 TOWER ROAD SUITE 300
MARIETTA GA
30060
US

IV. Provider business mailing address

355 TOWER ROAD SUITE 300
MARIETTA GA
30060
US

V. Phone/Fax

Practice location:
  • Phone: 770-426-4721
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: KATIE DOYLE
Title or Position: MANAGER, PHYSICIANS SERVICES
Credential:
Phone: 678-797-4113