Healthcare Provider Details

I. General information

NPI: 1700853041
Provider Name (Legal Business Name): KENNESTONE HOSPITAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 10/31/2024
Certification Date: 10/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2540 WINDY HILL RD SE
MARIETTA GA
30067-8605
US

IV. Provider business mailing address

1800 PARKWAY PL SE STE 500
MARIETTA GA
30067-8237
US

V. Phone/Fax

Practice location:
  • Phone: 470-644-0012
  • Fax:
Mailing address:
  • Phone: 470-956-4981
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282E00000X
TaxonomyLong Term Care Hospital
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: MR. ANTHONY J BUDZINSKI
Title or Position: EXECUTIVE VP & CFO
Credential:
Phone: 470-644-0012