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General NPI Number Information
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NPI Number | 1750904504
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Entity Type | Individual
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Provider Name | KYLE D MAXWELL MD
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Gender | Male
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Dates
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Enumeration Date | 05/27/2020
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Last Update Date | 07/24/2023
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Provider Practice Location Address
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Address Line | 1409 CHATTANOOGA AVE
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City | DALTON
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State | GA
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Zip | 30720-2631
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Country | US
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Telephone | 706-278-5373
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Fax |
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Provider Business Mailing Address
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Address Line | 7531 PFIZER DR
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City | OOLTEWAH
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State | TN
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Zip | 37363-5558
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Country | US
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Telephone | 423-704-2221
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 94846
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License Number State | GA
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