Healthcare Provider Details

I. General information

NPI: 1255331674
Provider Name (Legal Business Name): GEORGE KEVIN PERDUE D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: G KEVIN PERDUE D.O.

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 11/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1240 EAGLES LANDING PKWY SUITE 300
STOCKBRIDGE GA
30281
US

IV. Provider business mailing address

100 GALLERIA PKWY SE SUITE 410
ATLANTA GA
30339-3179
US

V. Phone/Fax

Practice location:
  • Phone: 770-506-4350
  • Fax:
Mailing address:
  • Phone: 770-953-6929
  • Fax: 770-953-6972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number050244
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: