Individual
DR. KENNETH S JAGO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
125 OAKSIDE CT STE 101, CANTON, GA 30114
(770) 479-3424
(770) 720-3454
Mailing address
125 OAKSIDE CT STE 101, CANTON, GA 30114
(770) 479-3424
(770) 720-3454
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
029476
GA
207Q00000X
Family Medicine Physician
29476
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00380575C
—
GA
Enumeration date
02/14/2006
Last updated
08/21/2019
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