Provider Demographics
NPI:1043200884
Name:HOOD, FRED KENNARD (MD)
Entity Type:Individual
Prefix:
First Name:FRED
Middle Name:KENNARD
Last Name:HOOD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 OLD JACKSON RD
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30252-3095
Mailing Address - Country:US
Mailing Address - Phone:678-490-0080
Mailing Address - Fax:678-490-0091
Practice Address - Street 1:65 OLD JACKSON RD
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30252-3095
Practice Address - Country:US
Practice Address - Phone:678-490-0080
Practice Address - Fax:678-490-0091
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA45071207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000819431AMedicaid
GA0100102OtherUNITED HEALTHCARE
GA10033108OtherAMERIGROUP
GA52728647001OtherBC/BS GEORGIA
GA8266OtherKAISER
GA1061050002OtherPEACHSTATE
GA314128OtherWELLCARE
GA080140397OtherRAILROAD MEDICARE
GAG90424Medicare UPIN
GA000819431AMedicaid
GA08BDPVQMedicare PIN