Provider Demographics
NPI:1740214220
Name:HEWLING, KIRK-CONROD P (MD)
Entity Type:Individual
Prefix:DR
First Name:KIRK-CONROD
Middle Name:P
Last Name:HEWLING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:900 TOWNE LAKE PKWY
Mailing Address - Street 2:STE 410
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30189-1602
Mailing Address - Country:US
Mailing Address - Phone:678-445-0819
Mailing Address - Fax:678-445-0927
Practice Address - Street 1:900 TOWNE LAKE PKWY
Practice Address - Street 2:STE 410
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-1602
Practice Address - Country:US
Practice Address - Phone:678-445-0819
Practice Address - Fax:678-445-0927
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA057559207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA151098660CMedicaid
GA2020I83084Medicare PIN