Provider Demographics
NPI:1114994605
Name:REMLEY, KENT B (MD)
Entity Type:Individual
Prefix:
First Name:KENT
Middle Name:B
Last Name:REMLEY
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 1:1665 HIGHWAY 34 E
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-2404
Mailing Address - Country:US
Mailing Address - Phone:317-815-7021
Mailing Address - Fax:317-815-8951
Practice Address - Street 1:1665 HIGHWAY 34 E
Practice Address - Street 2:SUITE 100
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-2404
Practice Address - Country:US
Practice Address - Phone:770-252-7557
Practice Address - Fax:770-252-7513
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01055206A2085R0202X, 208VP0014X
GA043462208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200076860Medicaid
E25304Medicare UPIN
GA202G707678Medicare PIN
IN200076860Medicaid