Provider Demographics
NPI:1750004792
Name:KAISER DYNAMIC HEALTH
Entity type:Organization
Organization Name:KAISER DYNAMIC HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CMO
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:I
Authorized Official - Last Name:CRAWFORD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-910-6098
Mailing Address - Street 1:7909 FAITH LN
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-3752
Mailing Address - Country:US
Mailing Address - Phone:404-910-6089
Mailing Address - Fax:
Practice Address - Street 1:180 E DANIA BEACH BLVD UNIT 1202
Practice Address - Street 2:
Practice Address - City:DANIA BEACH
Practice Address - State:FL
Practice Address - Zip Code:33004-3004
Practice Address - Country:US
Practice Address - Phone:404-910-6089
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-23
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty