| Kennestone Internal Medicine Associates Pc | |
|
790 Church St Ne Ste 325 Marietta GA 30060-7282 | |
| (770) 419-7074 | |
| Not Available |
| Full Name | Kennestone Internal Medicine Associates Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 790 Church St Ne, Marietta, Georgia |
| Authorized Official Name and Position | Renae Forrester (OFFICE MANAGER) |
| Authorized Official Contact | 7704197074 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kennestone Internal Medicine Associates Pc 790 Church St Ne Ste 325 Marietta GA 30060-7282 Ph: (770) 419-7074 | Kennestone Internal Medicine Associates Pc 790 Church St Ne Ste 325 Marietta GA 30060-7282 Ph: (770) 419-7074 |
| NPI Number | 1093931800 |
|---|---|
| Provider Enumeration Date | 04/18/2007 |
| Last Update Date | 01/16/2013 |
| Medicare PECOS PAC ID | 7416945704 |
|---|---|
| Medicare Enrollment ID | O20040505000248 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093931800 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | David Lahasky |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1336188598 PECOS PAC ID: 9931297645 Enrollment ID: I20081021000461 |
| Provider Name | Robert Joel Ollins |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1073523148 PECOS PAC ID: 5193858660 Enrollment ID: I20100804000509 |
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