Provider Demographics
NPI:1962655324
Name:KENNETH C MOLKNER MD PC
Entity Type:Organization
Organization Name:KENNETH C MOLKNER MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:C
Authorized Official - Last Name:MOLKNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-394-8254
Mailing Address - Street 1:2501 WINDY HILL RD SE
Mailing Address - Street 2:SUITE 245
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-8663
Mailing Address - Country:US
Mailing Address - Phone:770-394-8254
Mailing Address - Fax:770-953-8320
Practice Address - Street 1:2501 WINDY HILL RD SE
Practice Address - Street 2:SUITE 245
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-8663
Practice Address - Country:US
Practice Address - Phone:770-394-8254
Practice Address - Fax:770-953-8320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-29
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA009566103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
D30277Medicare UPIN
255545405AMedicare PIN