Organization
KENNESTONE HEART PHYSICIANS GROUP, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATIE DOYLE (MANAGER, PHYSICIAN SERVICES)
(678) 797-4113
Entity
Organization
Contact information
Practice address
2513 SHALLOWFORD RD, BUILDING 100, MARIETTA, GA 30066-6809
(770) 516-3500
(770) 516-3660
Mailing address
355 TOWER RD NE, SUITE 300, MARIETTA, GA 30060-9408
(770) 426-4721
(770) 424-0391
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
131843
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300025641K
—
GA
01
—
GRP938
MEDICAR PTAN
GA
Enumeration date
04/07/2009
Last updated
08/04/2009
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