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General NPI Number Information
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NPI Number | 1902877418
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Entity Type | Organization
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Legal Business Name | KENNESTONE HOSPTIAL, INC.
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Dates
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Enumeration Date | 02/01/2006
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Last Update Date | 02/24/2020
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Provider Practice Location Address
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Address Line | 3950 AUSTELL RD WELLSTAR BEHAVIORAL HEALTH CENTER
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City | AUSTELL
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State | GA
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Zip | 30106-1121
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Country | US
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Telephone | 770-732-6570
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Fax | 770-732-6549
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Provider Business Mailing Address
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Address Line | 2000 S PARK PL SE WINDY HILL EXCHANGE BUILDING
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City | ATLANTA
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State | GA
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Zip | 30339-2013
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Country | US
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Telephone | 770-956-6464
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Fax | 770-956-6463
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Authorized Official
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Title or Position | PRESIDENT & CEO
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Name | GREGORY L SIMONE
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Credential | MD
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Telephone | 770-792-7600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 283Q00000X
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Taxonomy Name | Psychiatric Hospital
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License Number | 033-432
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License Number State | GA
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