Provider Demographics
NPI:1467638130
Name:CARDONA, KENNETH (MD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:
Last Name:CARDONA
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 1:550 PEACHTREE STREET, NE STE 9000
Mailing Address - Street 2:EMORY HEALTHCARE MEDICAL OFFICE TOWER
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308
Mailing Address - Country:US
Mailing Address - Phone:404-727-0093
Mailing Address - Fax:404-727-3660
Practice Address - Street 1:550 PEACHTREE STREET, NE STE 9000
Practice Address - Street 2:EMORY HEALTHCARE MEDICAL OFFICE TOWER
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308
Practice Address - Country:US
Practice Address - Phone:404-727-0093
Practice Address - Fax:404-727-3660
Is Sole Proprietor?:No
Enumeration Date:2008-01-12
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA053682208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery