Individual
KEVIN N ROARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
777 HEMLOCK ST, MACON, GA 31201-2102
(478) 633-2129
Mailing address
777 HEMLOCK ST, MACON, GA 31201-2102
(478) 633-2129
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN160869
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RN160869
GA LICENSE NUMBER
GA
Enumeration date
02/07/2012
Last updated
02/07/2012
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