Provider Demographics
NPI:1659593077
Name:WILLIAM E. SNELL DO PC
Entity Type:Organization
Organization Name:WILLIAM E. SNELL DO PC
Other - Org Name:KENMAR FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:SNELL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:770-590-0585
Mailing Address - Street 1:880 CANTON ROAD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-7283
Mailing Address - Country:US
Mailing Address - Phone:770-590-0585
Mailing Address - Fax:770-428-4087
Practice Address - Street 1:880 CANTON ROAD
Practice Address - Street 2:SUITE 300
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-7283
Practice Address - Country:US
Practice Address - Phone:770-590-0585
Practice Address - Fax:770-428-4087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA024495208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000273391AMedicaid
GAGRP4464OtherMEDICARE
GADG6106OtherRAILROAD MEDICARE
GAD30850Medicare UPIN