=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386795383
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KENNEY S. ATKINS M.D.,P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/16/2007
-----------------------------------------------------
Last Update Date | 02/29/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4799 BLUE RIDGE DRIVE SUITE 100
-----------------------------------------------------
City | BLUE RIDGE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30513-0000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-964-3345
-----------------------------------------------------
Fax | 706-964-3347
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 669
-----------------------------------------------------
City | MC CAYSVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30555-0669
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-964-3345
-----------------------------------------------------
Fax | 706-964-3347
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DR. KENNEY SCOTT ATKINS
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 706-964-3345
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number | 024386
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------