| Kennesaw Pediatrics | |
|
3745 Cherokee St Nw Suite 401 Kennesaw GA 30144-6733 | |
| (770) 429-1005 | |
| (770) 429-8005 |
| Full Name | Kennesaw Pediatrics |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 3745 Cherokee St Nw, Kennesaw, Georgia |
| Authorized Official Name and Position | Mark Anthony Long (PRESIDENT) |
| Authorized Official Contact | 7704291005 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Kennesaw Pediatrics 3745 Cherokee St Nw Suite 401 Kennesaw GA 30144-6733 Ph: (770) 429-1005 | Kennesaw Pediatrics 3745 Cherokee St Nw Suite 401 Kennesaw GA 30144-6733 Ph: (770) 429-1005 |
| NPI Number | 1659565562 |
|---|---|
| Provider Enumeration Date | 09/04/2007 |
| Last Update Date | 09/04/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659565562 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 0048265 (Georgia) | Primary |
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