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General NPI Number Information
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NPI Number | 1548496433
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Entity Type | Organization
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Legal Business Name | KENNESTONE HEART PHYSICIANS GROUP, PC
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Dates
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Enumeration Date | 06/05/2009
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Last Update Date | 06/05/2009
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Provider Practice Location Address
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Address Line | 1230 JOHNSON FERRY PL SUITE 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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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 | MANAGER, PHYSICIAN SERVICES
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Name | KATIE DOYLE
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Credential |
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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 | 00058204
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License Number State | GA
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