Provider Demographics
NPI:1295734630
Name:MCGRATH, KENNETH G (DO)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:G
Last Name:MCGRATH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:275 COLLIER ROAD, NW
Mailing Address - Street 2:SUITE 500
Mailing Address - City:ALTANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-1740
Mailing Address - Country:US
Mailing Address - Phone:404-605-2800
Mailing Address - Fax:404-351-5983
Practice Address - Street 1:275 COLLIER ROAD, NW
Practice Address - Street 2:SUITE 500
Practice Address - City:ALTANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1740
Practice Address - Country:US
Practice Address - Phone:404-605-2800
Practice Address - Fax:404-351-5983
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2010-12-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA034890207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000474955BLQMedicaid
GA511I060045Medicare PIN
GA000474955BLQMedicaid