Organization
KENNESAW PEDIATRICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK ANTHONY LONG MD (PRESIDENT)
(770) 429-1005
Entity
Organization
Contact information
Practice address
3745 CHEROKEE ST NW, SUITE 401, KENNESAW, GA 30144-6733
(770) 429-1005
(770) 429-8005
Mailing address
3745 CHEROKEE ST NW, SUITE 401, KENNESAW, GA 30144-6733
(770) 429-1005
(770) 429-8005
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
0048265
GA
Other
Enumeration date
09/04/2007
Last updated
09/04/2007
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