Individual
KENNETH W FOGARTY II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2350 LIMESTONE PKWY, GAINESVILLE, GA 30501-2013
(770) 539-9600
(770) 534-1470
Mailing address
PO BOX 908653, GAINESVILLE, GA 30501-0926
(770) 539-9600
(770) 534-1470
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
041118
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000679599C
—
GA
01
—
0400123
UNITED HEALTHCARE
GA
01
—
10053087
AMERIGROUP
GA
01
—
110225630
RR MEDICARE-GRP # CC4177
GA
01
—
336330
WELLCARE
GA
01
—
52542692
BCBS
GA
01
—
8583747
CIGNA
GA
Enumeration date
01/18/2006
Last updated
07/16/2013
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