Provider Demographics
NPI:1811945835
Name:GARTH, KYENDRIA KELLOGG (MD)
Entity type:Individual
Prefix:
First Name:KYENDRIA
Middle Name:KELLOGG
Last Name:GARTH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 ZEBULON ROAD
Mailing Address - Street 2:
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30224
Mailing Address - Country:US
Mailing Address - Phone:770-227-5510
Mailing Address - Fax:770-228-8180
Practice Address - Street 1:1900 ZEBULON ROAD
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30224
Practice Address - Country:US
Practice Address - Phone:770-227-5510
Practice Address - Fax:770-228-8180
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA051293208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics