Organization
KENNESAW FAMILY PHYSICIANS PC
Active
Other names
Main Street Family Physicians
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CONNIE H. KELLER (OFFICE MANAGER)
(770) 422-1400
Entity
Organization
Contact information
Practice address
4791 S MAIN ST, ACWORTH, GA 30101-5324
(770) 422-1400
(678) 290-6728
Mailing address
4791 S MAIN ST, ACWORTH, GA 30101-5324
(770) 422-1400
(678) 290-6728
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
581584420
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
085000643G
—
GA
Enumeration date
01/30/2007
Last updated
10/22/2012
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