MEDICARE: KENNY M FRONTIN 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
1	207RG0100X	Gastroenterology Physician	035417	GA
2	207R00000X	Internal Medicine Physician	035417	GA

Other Identifiers

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

General Provider Information

NPI Number	:	1740280627
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNY M FRONTIN MD

Provider Business Mailing Address
First Line	:	3495 PIEDMONT RD NE
Second Line	:	NINE PIEDMONT CENTER
City	:	ATLANTA
State	:	GA
Zip	:	30305-1717
Country	:	US
Telephone Number	:	404-364-7000
Fax Number	:	404-364-4732

Provider Business Practice Location Address
First Line	:	2470 MOUNT ZION PKWY
Second Line	:	DEPARTMENT OF GASTROENTEROLOGY
City	:	JONESBORO
State	:	GA
Zip	:	30236-2500
Country	:	US
Telephone Number	:	770-603-3822
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2005
Last Update Date	:	01/13/2022

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Directions to “ KENNY M FRONTIN MD” Practice Location

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