Provider Demographics
NPI:1982818688
Name:ROLING, KENNETH CARSON (RPH)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:CARSON
Last Name:ROLING
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1185 ATHENS RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:CRAWFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30630
Mailing Address - Country:US
Mailing Address - Phone:706-743-5466
Mailing Address - Fax:706-743-3398
Practice Address - Street 1:1185 ATHENS RD
Practice Address - Street 2:SUITE 2
Practice Address - City:CRAWFORD
Practice Address - State:GA
Practice Address - Zip Code:30630
Practice Address - Country:US
Practice Address - Phone:706-743-8122
Practice Address - Fax:706-743-3398
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE005399183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00030115AMedicaid
GA00030115AMedicaid