Provider Demographics
NPI:1104848977
Name:ATKINS, KENNEY SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNEY
Middle Name:SCOTT
Last Name:ATKINS
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:PO BOX 669
Mailing Address - Street 2:
Mailing Address - City:MC CAYSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30555-0669
Mailing Address - Country:US
Mailing Address - Phone:706-964-3345
Mailing Address - Fax:706-964-3347
Practice Address - Street 1:4799 BLUE RIDGE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:BLUE RIDGE
Practice Address - State:GA
Practice Address - Zip Code:30513-3240
Practice Address - Country:US
Practice Address - Phone:706-964-3345
Practice Address - Fax:706-964-3347
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2010-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN16029207Q00000X
GA024386207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0595594OtherBLUE CROSS OF GEORGIA
GA00260763AMedicaid
TN0059988OtherBLUE CROSS OF TENNESSEE
TN3013267Medicaid
TNA97730Medicare UPIN
GA01BDHQBMedicare ID - Type Unspecified
110135419Medicare ID - Type UnspecifiedRAILROAD MEDICARE
GA00260763AMedicaid