| Kenmar Family Practice | |
|
880 Canton Road Suite 300 Marietta GA 30060-7283 | |
| (770) 590-0585 | |
| (770) 428-4087 |
| Full Name | Kenmar Family Practice |
|---|---|
| Speciality | General Practice |
| Location | 880 Canton Road, Marietta, Georgia |
| Authorized Official Name and Position | William Edward Snell (PRESIDENT) |
| Authorized Official Contact | 7705900585 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kenmar Family Practice 880 Canton Road Suite 300 Marietta GA 30060-7283 Ph: (770) 590-0585 | Kenmar Family Practice 880 Canton Road Suite 300 Marietta GA 30060-7283 Ph: (770) 590-0585 |
| NPI Number | 1659593077 |
|---|---|
| Provider Enumeration Date | 05/03/2007 |
| Last Update Date | 01/19/2023 |
| Medicare PECOS PAC ID | 0042259996 |
|---|---|
| Medicare Enrollment ID | O20050429000174 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659593077 | NPI | - | NPPES |
| 000273391A | Medicaid | GA | |
| GRP4464 | Other | GA | MEDICARE |
| DG6106 | Other | GA | RAILROAD MEDICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | 024495 (Georgia) | Primary |
| Provider Name | William E Snell |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1013932003 PECOS PAC ID: 1850330705 Enrollment ID: I20100316000211 |
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