Individual
KENNETH C. HOLBROOK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
2041 MESA VALLEY WAY, SUITE 100, AUSTELL, GA 30106-6828
(770) 944-1100
(770) 944-6469
Mailing address
2041 MESA VALLEY WAY, SUITE 100, AUSTELL, GA 30106-6828
(770) 944-1100
(770) 944-6469
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
003877
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000150059B
—
GA
05
—
000150059C
—
GA
05
—
100002161B
—
GA
Enumeration date
02/22/2006
Last updated
05/20/2011
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