Provider Demographics
NPI:1821583477
Name:KAO, LLC
Entity Type:Organization
Organization Name:KAO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:O'NEAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-614-6086
Mailing Address - Street 1:1210 LEXINGTON CT
Mailing Address - Street 2:
Mailing Address - City:BISHOP
Mailing Address - State:GA
Mailing Address - Zip Code:30621-6223
Mailing Address - Country:US
Mailing Address - Phone:706-614-6086
Mailing Address - Fax:
Practice Address - Street 1:1181 LANGFORD DR
Practice Address - Street 2:BLD 100 SUITE 101
Practice Address - City:WATKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30621
Practice Address - Country:US
Practice Address - Phone:706-546-9838
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-26
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA42378261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care