Individual
KENETTE ST-GOURDIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
631 CAMPBELL HILL ST NW STE 200, MARIETTA, GA 30060-1390
(770) 727-4130
(770) 800-1334
Mailing address
631 CAMPBELL HILL ST NW STE 200, MARIETTA, GA 30060-1390
(314) 448-3791
(636) 996-7658
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
96398
GA
208M00000X
Hospitalist Physician
2023049186
MO
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/03/2020
Last updated
12/04/2024
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