Organization
KENNESTONE FAMILY MEDICINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SAM PENG (MD)
(770) 820-3855
Entity
Organization
Contact information
Practice address
72 PLAZA WAY NW, MARIETTA, GA 30060-1104
(770) 795-8070
Mailing address
72 PLAZA WAY NW, MARIETTA, GA 30060-1104
(770) 795-8070
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
RN205404
GA
Other
Enumeration date
02/20/2017
Last updated
02/20/2017
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