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General NPI Number Information
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NPI Number | 1285732339
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Entity Type | Organization
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Legal Business Name | KINDRED HEALTHCARE
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 484 WINN WAY
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City | DECATUR
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State | GA
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Zip | 30030
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Country | US
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Telephone | 770-716-6203
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Fax |
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Provider Business Mailing Address
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Address Line | 484 WINN WAY
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City | DECATUR
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State | GA
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Zip | 30030
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | EUGENE W WILLIAMS
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Credential | DO
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Telephone | 770-716-6203
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 054954
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License Number State | GA
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