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General NPI Number Information
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NPI Number | 1407805872
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Entity Type | Individual
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Provider Name | BRIAN KEITH NADOLNE M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/10/2006
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Last Update Date | 04/26/2021
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Provider Practice Location Address
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Address Line | 1121 JOHNSON FERRY RD STE 320
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City | MARIETTA
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State | GA
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Zip | 30068-5404
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Country | US
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Telephone | 770-509-0017
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Fax | 770-971-7818
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Provider Business Mailing Address
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Address Line | 1230 JOHNSON FERRY PL STE B-10
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City | MARIETTA
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State | GA
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Zip | 30068-2048
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Country | US
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Telephone | 770-509-0017
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Fax | 770-971-7818
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 040748
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License Number State | GA
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