Organization
KENNESTONE HEART PHYSICIANS GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WM MICHAEL BROWN M.D. (PRESIDENT)
(678) 797-4113
Entity
Organization
Contact information
Practice address
200 OAKSIDE LN, SUITE D, CANTON, GA 30114-6416
(770) 426-4721
(678) 880-6513
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
2009PROFS-0051
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300025641K
—
GA
Enumeration date
03/05/2009
Last updated
03/05/2009
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