Healthcare Provider Details

I. General information

NPI: 1952330946
Provider Name (Legal Business Name): WILLIAM KENT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 03/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 MIMS RD
SYLVANIA GA
30467-1994
US

IV. Provider business mailing address

PO BOX 532768
ATLANTA GA
30353-2768
US

V. Phone/Fax

Practice location:
  • Phone: 904-805-1300
  • Fax: 904-805-1302
Mailing address:
  • Phone: 904-805-1300
  • Fax: 904-805-1302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number9535
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: