Individual
MR. KENNETH DALE AUTRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
FNP
Contact information
Practice address
726 S 8TH ST, GRIFFIN, GA 30224-4827
(770) 228-2273
Mailing address
83 MOORE RD, GRIFFIN, GA 30223-5526
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
RN162470
GA
Other
Enumeration date
05/17/2022
Last updated
05/17/2022
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