Provider Demographics
NPI:1508822776
Name:MENCHION, KENNETH F (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:F
Last Name:MENCHION
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:350 COUNTRY CLUB DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-9084
Mailing Address - Country:US
Mailing Address - Phone:770-692-4000
Mailing Address - Fax:770-474-8510
Practice Address - Street 1:350 COUNTRY CLUB DR
Practice Address - Street 2:SUITE A
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-9084
Practice Address - Country:US
Practice Address - Phone:770-692-4000
Practice Address - Fax:770-474-8510
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2020-09-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA0472362086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000821378DMedicaid
GA000821378DMedicaid
GA77BBBNJMedicare PIN