Provider Demographics
NPI:1861483638
Name:WEBSTER, KEVIN DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:DAVID
Last Name:WEBSTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 DOCTORS DR
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30117-4486
Mailing Address - Country:US
Mailing Address - Phone:770-834-6208
Mailing Address - Fax:770-830-7620
Practice Address - Street 1:101 DOCTORS DR
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-4486
Practice Address - Country:US
Practice Address - Phone:770-834-6208
Practice Address - Fax:770-830-7620
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA041384207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00701071BMedicare ID - Type Unspecified
GA11BDNNZMedicare ID - Type Unspecified
GAG30252Medicare UPIN