Organization
KENNETH A. HOOSE, JR., M.D., P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KENNETH ARTHUR HOOSE JR. M.D. (PRESIDENT)
(404) 501-7640
Entity
Organization
Contact information
Practice address
2675 N DECATUR RD, SUITE 607, DECATUR, GA 30033-6131
(404) 501-7640
(404) 501-7601
Mailing address
2675 N DECATUR RD, SUITE 607, DECATUR, GA 30033-6131
(404) 501-7640
(404) 501-7601
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
10962
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000098876A
—
GA
01
—
011003745
MEDICARE RAILROAD
GA
01
—
048575
BLUE CROSS/BLUE SHIELD
GA
Enumeration date
01/18/2008
Last updated
09/02/2010
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