Provider Demographics
NPI:1518207612
Name:KENNESAW STATE UNIVERSITY
Entity Type:Organization
Organization Name:KENNESAW STATE UNIVERSITY
Other - Org Name:KENNEWAW STATE UNIVERSITY STUDENT HEALTH SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:PROCUREMENT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLFE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-420-4355
Mailing Address - Street 1:1000 CHASTAIN RD NW
Mailing Address - Street 2:MD5200 HOUSE 52
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-5588
Mailing Address - Country:US
Mailing Address - Phone:770-423-6644
Mailing Address - Fax:770-499-3655
Practice Address - Street 1:1000 CHASTAIN RD NW
Practice Address - Street 2:MD5200 HOUSE 52
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-5588
Practice Address - Country:US
Practice Address - Phone:770-423-6644
Practice Address - Fax:770-499-3655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-26
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health