Provider Demographics
NPI:1407805872
Name:NADOLNE, BRIAN KEITH (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:KEITH
Last Name:NADOLNE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1230 JOHNSON FERRY PL
Mailing Address - Street 2:STE B-10
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30068-2048
Mailing Address - Country:US
Mailing Address - Phone:770-509-0017
Mailing Address - Fax:770-971-7818
Practice Address - Street 1:1121 JOHNSON FERRY RD STE 320
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30068-5404
Practice Address - Country:US
Practice Address - Phone:770-509-0017
Practice Address - Fax:770-971-7818
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA040748207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA5656896OtherCIGNA
GA7394560OtherAETNA
GA000739505EMedicaid
GA52543664OtherB/C B/S OF GEORGIA
GA1073451OtherCOVENTRY HEALTHCARE
GA176614008OtherUNITED HEALTHCARE
GAP00243653OtherRAILROAD MEDICARE
GAP00243653OtherRAILROAD MEDICARE
GA1073451OtherCOVENTRY HEALTHCARE