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General NPI Number Information
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NPI Number | 1205932175
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Entity Type | Individual
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Provider Name | KENNETH L NORRIS P.A.
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Gender | Male
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Dates
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Enumeration Date | 09/16/2006
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Last Update Date | 09/16/2020
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Provider Practice Location Address
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Address Line | 631 PROFESSIONAL DR SUITE 200
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-3367
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Country | US
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Telephone | 678-312-3500
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Fax | 678-312-3529
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Provider Business Mailing Address
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Address Line | PO BOX 116156
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City | ATLANTA
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State | GA
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Zip | 30368-6156
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Country | US
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Telephone | 470-325-0100
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Fax | 470-325-0193
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 002268
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License Number State | GA
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