Provider Demographics
NPI:1346453008
Name:KENNESTONE NEUROLOGY ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:KENNESTONE NEUROLOGY ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:R
Authorized Official - Last Name:VILLASANA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-426-3977
Mailing Address - Street 1:711 CANTON RD NE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-8948
Mailing Address - Country:US
Mailing Address - Phone:770-426-3977
Mailing Address - Fax:770-421-8567
Practice Address - Street 1:711 CANTON RD NE
Practice Address - Street 2:SUITE 210
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-8948
Practice Address - Country:US
Practice Address - Phone:770-426-3977
Practice Address - Fax:770-421-8567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty