Healthcare Provider Details

I. General information

NPI: 1043200884
Provider Name (Legal Business Name): FRED KENNARD HOOD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2005
Last Update Date: 02/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 OLD JACKSON RD
MCDONOUGH GA
30252-3095
US

IV. Provider business mailing address

65 OLD JACKSON RD
MCDONOUGH GA
30252-3095
US

V. Phone/Fax

Practice location:
  • Phone: 678-490-0080
  • Fax: 678-490-0091
Mailing address:
  • Phone: 678-490-0080
  • Fax: 678-490-0091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number45071
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: