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General NPI Number Information
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NPI Number | 1306086228
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Entity Type | Organization
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Legal Business Name | KENNESTONE HEART PHYSICIANS GROUP
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Dates
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Enumeration Date | 03/05/2009
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Last Update Date | 03/05/2009
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Provider Practice Location Address
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Address Line | 200 OAKSIDE LN SUITE D
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City | CANTON
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State | GA
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Zip | 30114-6416
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Country | US
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Telephone | 770-426-4721
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Fax | 678-880-6513
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Provider Business Mailing Address
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Address Line | 355 TOWER RD NE SUITE 300
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City | MARIETTA
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State | GA
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Zip | 30060-9408
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Country | US
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Telephone | 770-426-4721
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Fax | 770-424-0391
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. WM MICHAEL BROWN
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Credential | M.D.
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Telephone | 678-797-4113
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 2009PROFS-0051
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License Number State | GA
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