Provider Demographics
NPI:1740218072
Name:ONEAL, KEVIN A (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:A
Last Name:ONEAL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1181 LANGFORD DR
Mailing Address - Street 2:BLDG 100 STE 101
Mailing Address - City:BOGART
Mailing Address - State:GA
Mailing Address - Zip Code:30622-2542
Mailing Address - Country:US
Mailing Address - Phone:706-546-9838
Mailing Address - Fax:706-546-9347
Practice Address - Street 1:1181 LANGFORD DR
Practice Address - Street 2:BLDG 100 STE 101
Practice Address - City:BOGART
Practice Address - State:GA
Practice Address - Zip Code:30622-2542
Practice Address - Country:US
Practice Address - Phone:706-546-9838
Practice Address - Fax:706-546-9347
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2014-04-25
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Provider Licenses
StateLicense IDTaxonomies
GA042378207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000752353BMedicaid
GAG56009Medicare UPIN
GA000752353BMedicaid