NPIMap

Organization Active NPI

Kennestone Heart Physicians Group, PC

  • Cardiovascular Disease Physician
  • Canton, GA
National Provider Identifier
1184864258
Registry record updated May 21, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
2009PROFS-0051 Issued in GA
Legal business name
KENNESTONE HEART PHYSICIANS GROUP, PC
Practice address
720 Transit Ave
Building 100, Suite 102
Canton, GA 30114-2540
Phone
(770) 426-4721
Fax
(770) 424-0391
NPI assigned
Mar 2, 2009
Last updated
May 21, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 21, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Katie Doyle I
Title
Manager, Physician Services
Phone
(678) 797-4113

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RC0000X 2009PROFS-0051 GA Primary

Addresses

Primary practice location

720 Transit Ave
Building 100, Suite 102
Canton, GA 30114-2540

Mailing address

355 Tower Rd NE
Suite 300
Marietta, GA 30060-9408
Phone (770) 426-4721

Other identifiers 1

IdentifierTypeStateIssuer
300025641KMedicaidGA

National Provider Directory

National Provider Directory

Locations

140 Lacy St NW
Ste B
Marietta, GA 30060
Phone (770) 426-4721

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1235952000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1242864000000",
    "number": "1184864258",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "355 TOWER RD NE",
            "address_2": "SUITE 300",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300609408",
            "telephone_number": "770-426-4721",
            "fax_number": "770-424-0391"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "720 TRANSIT AVE",
            "address_2": "BUILDING 100, SUITE 102",
            "city": "CANTON",
            "state": "GA",
            "postal_code": "301142540",
            "telephone_number": "770-426-4721",
            "fax_number": "770-424-0391"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENNESTONE HEART PHYSICIANS GROUP, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-03-02",
        "last_updated": "2009-05-21",
        "status": "A",
        "authorized_official_last_name": "DOYLE",
        "authorized_official_first_name": "KATIE",
        "authorized_official_title_or_position": "MANAGER, PHYSICIAN SERVICES",
        "authorized_official_telephone_number": "678-797-4113",
        "authorized_official_name_suffix": "I"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "GA",
            "license": "2009PROFS-0051",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300025641K",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Canton, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.