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General NPI Number Information
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NPI Number | 1821583477
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Entity Type | Organization
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Legal Business Name | KAO, LLC
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Dates
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Enumeration Date | 06/26/2018
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Last Update Date | 06/26/2018
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Provider Practice Location Address
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Address Line | 1181 LANGFORD DR BLD 100 SUITE 101
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City | WATKINSVILLE
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State | GA
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Zip | 30621
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Country | US
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Telephone | 706-546-9838
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Fax |
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Provider Business Mailing Address
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Address Line | 1210 LEXINGTON CT
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City | BISHOP
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State | GA
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Zip | 30621-6223
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Country | US
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Telephone | 706-614-6086
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Fax |
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Authorized Official
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Title or Position | OWNER/MEMBER
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Name | KEVIN O'NEAL
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Credential |
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Telephone | 706-614-6086
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 42378
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License Number State | GA
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