Doctor Name: | DR. KENNETH L MCRAE |
NPI Number: | 1245397702 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | DC |
License Number: | 008066 |
Business Practice Address: | 2325 Log Cabin Dr Se Suite 107 Smyrna, GA - 300806798 |
Business Phone Number: | 7704321199 |
Business Fax Number: | 7704321195 |
Mailing Address: | 2325 Log Cabin Dr Se, Suite 107 SMYRNA |
State: | GA |
Postal Code: | 300806798 |
Phone Number: | 7704321199 |
Fax Number: | 7704321195 |
NPI Enumeration Date: | 01/03/2007 |
NPI Last Update Date: | 05/21/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 332B00000X |
License Number: | 008066 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | GA |
Taxonomy Type: | Suppliers |
Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
Taxonomy Specialization: | |
Taxonomy Definition: | A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient |