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General NPI Number Information
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NPI Number | 1669905964
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Entity Type | Individual
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Provider Name | KEVIN VAN SMAALEN MD
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Gender | Male
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Dates
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Enumeration Date | 04/04/2017
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Last Update Date | 08/28/2023
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Provider Practice Location Address
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Address Line | 1968 PEACHTREE RD NW
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City | ATLANTA
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State | GA
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Zip | 30309-1281
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Country | US
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Telephone | 404-605-2054
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Fax |
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Provider Business Mailing Address
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Address Line | 536 RIMROCK TRL
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City | STONE MOUNTAIN
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State | GA
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Zip | 30083-4555
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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 |
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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 | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | 94944
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License Number State | GA
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