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General NPI Number Information
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NPI Number | 1750625364
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Entity Type | Organization
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Legal Business Name | KENNETH E. DINELLA MD LLC
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Dates
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Enumeration Date | 11/20/2012
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Last Update Date | 11/20/2012
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Provider Practice Location Address
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Address Line | 1120 ELM AVE
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City | AMERICUS
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State | GA
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Zip | 31709-4253
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Country | US
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Telephone | 229-928-8868
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Fax | 229-928-8919
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Provider Business Mailing Address
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Address Line | PO BOX 686
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City | AMERICUS
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State | GA
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Zip | 31709-0686
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Country | US
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Telephone | 229-928-8868
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Fax | 229-928-8919
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | DR. KENNETH EDWARD DINELLA
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Credential | M.D.
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Telephone | 229-928-8868
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 036716
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License Number State | GA
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