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Individual

KENT R. NILSSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
1199 PRINCE AVE, MSB 2ND FLOOR, ATHENS, GA 30606-2797
(706) 475-1700
(706) 475-1790
Mailing address
PO BOX 161435, ATLANTA, GA 30321-1435
(706) 369-5440
(706) 369-5490

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
2005-00874
NC
207RC0000X
Cardiovascular Disease Physician
068459
GA
207RC0001X
Clinical Cardiac Electrophysiology Physician
Primary
068459
GA

Other

Enumeration date
10/07/2005
Last updated
09/17/2015
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