# KENNESAW FAMILY PHYSICIANS PC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Main Street Family Physicians
- **Organization subpart:** No

## Provider details

- **NPI number:** 1881730455
- **Authorized official:** MRS. CONNIE H. KELLER (OFFICE MANAGER)
- **Authorized official phone:** (770) 422-1400

## Contact information

- **Practice address:** 4791 S MAIN ST, ACWORTH, GA 30101-5324
- **Practice address phone:** (770) 422-1400
- **Practice address fax:** (678) 290-6728
- **Mailing address:** 4791 S MAIN ST, ACWORTH, GA 30101-5324
- **Mailing address phone:** (770) 422-1400
- **Mailing address fax:** (678) 290-6728

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 581584420 | GA | Yes |

## Other

- **Enumeration date:** 01/30/2007
- **Last updated:** 10/22/2012