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NPI Code Detail

MEDICARE: KENNETH J GARGAN MD

MEDICARE: KENNETH J GARGAN MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12085R0202XDiagnostic Radiology Physician055363GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1154375079
Entity Type Code : Individual
Provider Name (Legal Business Name) : KENNETH J GARGAN MD
Provider Business Mailing Address
First Line : PO BOX 2994
Second Line :
City : KENNESAW
State : GA
Zip : 30156-9181
Country : US
Telephone Number : 770-779-2171
Fax Number :
Provider Business Practice Location Address
First Line : 3949 S COBB DR SE
Second Line :
City : SMYRNA
State : GA
Zip : 30080-6342
Country : US
Telephone Number : 770-434-0710
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/22/2006
Last Update Date : 07/10/2008

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