Provider Demographics
NPI:1447432067
Name:MCKENNA, STANTON M (MD)
Entity Type:Individual
Prefix:DR
First Name:STANTON
Middle Name:M
Last Name:MCKENNA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4920 ROSWELL RD NE STE 35
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-2636
Mailing Address - Country:US
Mailing Address - Phone:404-303-2323
Mailing Address - Fax:404-303-0321
Practice Address - Street 1:4920 ROSWELL RD NE STE 35
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-2636
Practice Address - Country:US
Practice Address - Phone:404-303-2323
Practice Address - Fax:404-303-0321
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-05
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA59100208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice