KENNESTONE HEART PHYSICIANS GROUP (NPI# 1699721662) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1699721662 |
| Entity Type | Organization |
| Organization Name | KENNESTONE HEART PHYSICIANS GROUP |
| Other Organization Name | KENNESTONE HEART PHYSICIANS GROUP |
| Practice Address |
355 Tower Road Suite 300 Marietta GA 30060 |
| Practice Telephone | 7704264721 |
| Enumeration Date | 2006-05-25 |
| Last Update Date | 2009-04-10 |
| Authorized Official Name | KATIE DOYLE (MANAGER, PHYSICIANS SERVICES) |
| Authorized Official Telephone | 6787974113 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RC0000X |
Internal Medicine Specialization: Cardiovascular Disease |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | 300025641K | 05 |
| Other Name | Type Code |
|---|---|
| Kennestone Heart Physicians Group | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306086228 | Kennestone Heart Physicians Group | Internal Medicine | 200 Oakside Ln, Suite D, Canton, GA 30114-6416 | 2009-03-05 |
| 1003011776 | Kennestone Heart Physicians Group | Internal Medicine | 101 Riverstone Vis, Suite 217, Blue Ridge, GA 30513-6648 | 2007-06-20 |
| 1962566042 | Kennestone Heart Physicians Group | Internal Medicine | 120 Stonebridge Pkwy, Suite 440, Woodstock, GA 30189-3767 | 2006-12-21 |
| Street Address |
355 TOWER ROAD SUITE 300 |
| City | MARIETTA |
| State | GA |
| Zip Code | 30060 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144845116 | Legacy Center for Spinal Surgery, LLC | Neurological Surgery | 1900 The Exchange, Ne, Suite 600, Marietta, GA 30060 | 2020-06-15 |
| 1407477193 | Michael Cynil Daniel | Counselor | 698 N Marietta, Pkwy, Marietta, GA 30060 | 2020-05-04 |
| 1285253401 | Cameron Thomas Kennelly | Student in an Organized Health Care Education/Training Program | 677 Church Street Ne Attn:gme, Marietta, GA 30060 | 2020-04-09 |
| 1922640739 | Jeremiah George Blair | Physician Assistant | 61 Whitcher St Suite 2100, Marietta, GA 30060 | 2019-10-14 |
| 1164064945 | Denise Alicia Mick | Registered Nurse | 677 Church St Wellstar Kennestone Hospital, Marietta, GA 30060 | 2019-10-12 |
| 1184283772 | Iora Health Georgia, P.C. | Internal Medicine | 280 Cobb Pkwy Se, Suite 60, Marietta, GA 30060 | 2019-06-07 |
| 1346703212 | Caitlin Virginia Mueller | Student in an Organized Health Care Education/Training Program | 677 Church Street Ne, Attn: Gme, Marietta, GA 30060 | 2019-04-08 |
| 1184187205 | Adero Francis | Student in an Organized Health Care Education/Training Program | Wellstar Kennestone Gme Internal Medicine Clinic, 833 Campbell Hill St Nw, Suite 250, Marietta, GA 30060 | 2019-04-08 |
| 1659832749 | Matthew Mozzo | Student in an Organized Health Care Education/Training Program | 677 Church Street / Lower Level, Gme Department / I.m., Marietta, GA 30060 | 2019-03-29 |
| 1245797430 | La'myia Spentz | Specialist | 109 Anderson St Ne, Suite 608, Marietta, GA 30060 | 2019-02-25 |
| Find all providers in zip 30060 | ||||
| Taxonomy Code | 207RC0000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Cardiovascular Disease |
| An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms. |
| Notes: Source: American Osteopathic Board of Internal Medicine, 2008 [7/1/2008: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, http://www.abim.org/. American Osteopathic Board of Internal Medicine, https://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972528040 | Jennifer M Jones | Internal Medicine | 400 Matthew St Ste 302, Marietta, OH 45750-1656 | 2006-07-12 |
| 1447291216 | Vineet Dua | Internal Medicine | 3747 Roswell Rd Ste 213, Marietta, GA 30062-6227 | 2006-06-10 |
| 1821066739 | Gregory L Simone | Internal Medicine | 604 Keeler Woods Dr Nw, Marietta, GA 30064-2064 | 2006-03-08 |
| 1285639641 | Joseph R Mayo | Internal Medicine | 400 Matthew St, Ste 302, Marietta, OH 45750-1644 | 2005-06-14 |
| 1336543529 | Wellstar Medical Group, LLC | Internal Medicine | 61 Whitcher St Ne, Suite 4100b, Marietta, GA 30060-1181 | 2014-10-16 |
| 1386064962 | Joshua Randall Clevenger | Internal Medicine | 400 Matthew St Ste 302, Marietta, OH 45750-1656 | 2014-04-22 |
| 1306178256 | Motaz Moussa | Internal Medicine | 400 Matthew St, Suite 302, Marietta, OH 45750-1644 | 2010-02-03 |
| 1548496433 | Kennestone Heart Physicians Group, PC | Internal Medicine | 1230 Johnson Ferry Pl, Suite B-10, Marietta, GA 30068-2048 | 2009-06-05 |
| 1538303409 | Richard A Bardack | Internal Medicine | 55 Whitcher St Ne, Suite 350, Marietta, GA 30060-1155 | 2009-04-22 |
| 1285877274 | Kennestone Heart Physicians Group, PC | Internal Medicine | 2513 Shallowford Rd, Building 100, Marietta, GA 30066-6809 | 2009-04-07 |
| Find all providers in MARIETTA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.