Individual
KRISTINA NICHOLE BOGAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
3450 ACWORTH DUE WEST RD, BLDG 200, SUITE 220, KENNESAW, GA 30144-3335
(770) 456-5941
(770) 456-5942
Mailing address
3450 ACWORTH DUE WEST RD, BLDG 200, SUITE 220, KENNESAW, GA 30144-3335
(770) 456-5941
(770) 456-5942
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
061943
GA
207Q00000X
Family Medicine Physician
M0667
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1795445
—
TX
05
—
863007771D
—
GA
Enumeration date
06/03/2006
Last updated
01/23/2020
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