Provider Demographics
NPI:1831148063
Name:RICE, KENNETH MACLEOD (MD)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:MACLEOD
Last Name:RICE
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2021 MARKET PLACE BLVD
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-7931
Mailing Address - Country:US
Mailing Address - Phone:770-292-9982
Mailing Address - Fax:470-297-3347
Practice Address - Street 1:2021 MARKET PLACE BLVD
Practice Address - Street 2:PRIME CARE URGENT CARE
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-7931
Practice Address - Country:US
Practice Address - Phone:770-292-9982
Practice Address - Fax:470-297-3347
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-06
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC23639207P00000X
GA047251207P00000X
AZ25321207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ25321OtherARIZONA MEDICAL LICENSE
SCG47251Medicaid
TXU6648OtherTEXAS MEDICAL LICENSE
SC000823292HMedicaid
GA93BDLDNMedicare PIN
SC000823292HMedicaid
G31984Medicare UPIN
SCG47251Medicaid