Organization
KENNETH E. DINELLA MD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KENNETH EDWARD DINELLA M.D. (AUTHORIZED OFFICIAL)
(229) 928-8868
Entity
Organization
Contact information
Practice address
1120 ELM AVE, AMERICUS, GA 31709-4253
(229) 928-8868
(229) 928-8919
Mailing address
PO BOX 686, AMERICUS, GA 31709-0686
(229) 928-8868
(229) 928-8919
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
036716
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00553253A
—
GA
01
—
26BDCVB
MEDICARE PTAN
GA
Enumeration date
11/20/2012
Last updated
11/20/2012
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