Provider Demographics
NPI:1346236411
Name:JOEL, KENNETH HOWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:HOWARD
Last Name:JOEL
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 1:3333 OLD MILTON PKWY STE 400
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-4437
Mailing Address - Country:US
Mailing Address - Phone:770-391-3979
Mailing Address - Fax:770-391-0020
Practice Address - Street 1:3333 OLD MILTON PKWY
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-4437
Practice Address - Country:US
Practice Address - Phone:770-391-3979
Practice Address - Fax:770-391-0020
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA027837207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000383556CMedicaid
GA000383556BMedicaid
GA000383556DMedicaid
GA000383556FMedicaid
GA000383556GMedicaid
GA000383556EMedicaid
GA050044306OtherRAILROAD MEDICARE
GA000383556EMedicaid
GA000383556CMedicaid