Provider Demographics
NPI:1053862128
Name:MYERS, KENNETH GEORGE JR (MA)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:GEORGE
Last Name:MYERS
Suffix:JR
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 S LAMONT ST
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:GA
Mailing Address - Zip Code:31714-5329
Mailing Address - Country:US
Mailing Address - Phone:229-854-4886
Mailing Address - Fax:
Practice Address - Street 1:1511 W 3RD AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31707-3695
Practice Address - Country:US
Practice Address - Phone:229-854-4886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-24
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor