Provider Demographics
NPI:1699177428
Name:KENNESTONE HOSPITAL INC
Entity Type:Organization
Organization Name:KENNESTONE HOSPITAL INC
Other - Org Name:WELLSTAR PHARMACY NETWORK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:SNEHAL
Authorized Official - Middle Name:
Authorized Official - Last Name:DOSHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:470-644-0392
Mailing Address - Street 1:PO BOX 743081
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3081
Mailing Address - Country:US
Mailing Address - Phone:470-956-0170
Mailing Address - Fax:678-560-5948
Practice Address - Street 1:3747 ROSWELL RD
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-6215
Practice Address - Country:US
Practice Address - Phone:470-956-0170
Practice Address - Fax:678-560-5948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-24
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE0100723336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2147795OtherPK
GA003151812AMedicaid