Provider Demographics
NPI:1376589119
Name:NAGEL, KERRY (DO)
Entity Type:Individual
Prefix:DR
First Name:KERRY
Middle Name:
Last Name:NAGEL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:KERRY
Other - Middle Name:
Other - Last Name:NAGEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:3827 JIMMY LEE SMITH PKWY
Mailing Address - Street 2:
Mailing Address - City:HIRAM
Mailing Address - State:GA
Mailing Address - Zip Code:30141-2630
Mailing Address - Country:US
Mailing Address - Phone:770-222-8900
Mailing Address - Fax:770-222-2757
Practice Address - Street 1:3827 JIMMY LEE SMITH PKWY
Practice Address - Street 2:
Practice Address - City:HIRAM
Practice Address - State:GA
Practice Address - Zip Code:30141-2630
Practice Address - Country:US
Practice Address - Phone:770-222-8900
Practice Address - Fax:770-222-2757
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA58108207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAF40251Medicare UPIN