Kennestone Hospital, Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

KENNESTONE HOSPITAL, INC

Practice address

3950 Austell Rd
Suite 8
Austell, GA 30106-1121

Phone

(470) 732-2111

Fax

(678) 495-8798

NPI assigned

Mar 21, 2011

Organization subpart

No

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

Authorized official

Name

Ebenezer Erzuah

Title

Exec Director Reimbursement

Phone

(470) 956-4981

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• WellStar Pharmacy Network Doing business as

Tax ID family

Cobb Hosp Medical Cen4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

• Cobb Hospital Inc

  • Pharmacy
  • Smyrna, GA
  • NPI 1235658030
  NPD tax ID
• Cobb Hospital, Inc

  • Rehabilitation Hospital Unit
  • Austell, GA
  • NPI 1619967494
  NPD tax ID
• Wellstar Home Health, LLC

  • Home Health Agency
  • Marietta, GA
  • NPI 1073591376
  NPD tax ID

Locations

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

{
    "created_epoch": "1300665600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1588723200000",
    "number": "1386943009",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 741705",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303741705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3950 AUSTELL RD",
            "address_2": "SUITE 8",
            "city": "AUSTELL",
            "state": "GA",
            "postal_code": "301061121",
            "telephone_number": "470-732-2111",
            "fax_number": "678-495-8798"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENNESTONE HOSPITAL, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-03-21",
        "last_updated": "2020-05-06",
        "certification_date": "2020-05-06",
        "status": "A",
        "authorized_official_last_name": "ERZUAH",
        "authorized_official_first_name": "EBENEZER",
        "authorized_official_title_or_position": "EXEC DIRECTOR REIMBURSEMENT",
        "authorized_official_telephone_number": "470-956-4981"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2129620",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003112057A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WellStar Pharmacy Network",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "WellStar Pharmacy Network",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Katie Clinics, Inc
• Kathleen Ann Keirn, PA-C
• Keith Braswell, LLC
• Chastaine Kendrick, CNM
• Stacy H. Kendrick, PA
• Kennestone Hosptial, Inc.
• Kevin Wayne Kersee Jr., D.C.
• Christine M Keyser, DMD
• Mali Khamissi Sobi
• Mohammad Raza Khan

• All providers in Austell, GA
• Community/Retail Pharmacy in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2020; 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.