Healthcare Provider Details

I. General information

NPI: 1053318774
Provider Name (Legal Business Name): HOWARD KENNETH HERMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 02/09/2022
Certification Date: 02/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 EAGLES LANDING PKWY STE 102
STOCKBRIDGE GA
30281-7366
US

IV. Provider business mailing address

1240 HIGHWAY 54 W BLDG 700 STE 710
FAYETTEVILLE GA
30214-4565
US

V. Phone/Fax

Practice location:
  • Phone: 770-389-0000
  • Fax: 770-389-0168
Mailing address:
  • Phone: 678-534-5922
  • Fax: 770-997-3827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YS0012X
TaxonomySleep Medicine (Otolaryngology) Physician
License Number036777
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number036777
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: