Individual
KENNETH GENOVA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
300 MEDICAL DR, SUITE 705, LAGRANGE, GA 30240-4155
(706) 885-0111
(706) 885-0607
Mailing address
300 MEDICAL DR, SUITE 705, LAGRANGE, GA 30240-4155
(706) 885-0111
(706) 885-0607
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
036977
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00542055A
—
GA
Enumeration date
03/16/2006
Last updated
05/16/2008
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