Healthcare Provider Details

I. General information

NPI: 1225275753
Provider Name (Legal Business Name): MR. KAVIN K MCGEE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2009
Last Update Date: 01/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

882 ROCK QUARRY RD
STOCKBRIDGE GA
30281-4351
US

IV. Provider business mailing address

882 ROCK QUARRY RD
STOCKBRIDGE GA
30281-4351
US

V. Phone/Fax

Practice location:
  • Phone: 678-858-5922
  • Fax: 678-379-4672
Mailing address:
  • Phone: 678-858-5922
  • Fax: 678-379-4672

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: