Individual
DR. KENNETH O'NEAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1412 MILSTEAD AVE NE, CONYERS, GA 30012-3877
(770) 918-3000
Mailing address
1215 TUSCANY DR, SUITE A, BRASELTON, GA 30517-3488
(770) 307-1880
(770) 307-1889
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
060951
GA
207R00000X
Internal Medicine Physician
309691
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
759558453A
—
GA
Enumeration date
11/02/2006
Last updated
08/03/2022
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