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General NPI Number Information
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NPI Number | 1962655324
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Entity Type | Organization
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Legal Business Name | KENNETH C MOLKNER MD PC
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Dates
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Enumeration Date | 10/29/2008
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Last Update Date | 10/29/2008
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Provider Practice Location Address
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Address Line | 2501 WINDY HILL RD SE SUITE 245
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City | MARIETTA
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State | GA
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Zip | 30067-8663
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Country | US
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Telephone | 770-394-8254
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Fax | 770-953-8320
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Provider Business Mailing Address
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Address Line | 2501 WINDY HILL RD SE SUITE 245
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City | MARIETTA
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State | GA
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Zip | 30067-8663
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Country | US
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Telephone | 770-394-8254
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Fax | 770-953-8320
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Authorized Official
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Title or Position | OWNER
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Name | DR. KENNETH C MOLKNER
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Credential | MD
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Telephone | 770-394-8254
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 009566
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License Number State | GA
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