1831148063 NPI number — DR. KENNETH MACLEOD RICE M.D.

Table of content: DR. KENNETH MACLEOD RICE M.D. (NPI 1831148063)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831148063 NPI number — DR. KENNETH MACLEOD RICE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RICE
Provider First Name:
KENNETH
Provider Middle Name:
MACLEOD
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1831148063
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/19/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2021 MARKET PLACE BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CUMMING
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30041-7931
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-292-9982
Provider Business Mailing Address Fax Number:
470-297-3347

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2021 MARKET PLACE BLVD
Provider Second Line Business Practice Location Address:
PRIME CARE URGENT CARE
Provider Business Practice Location Address City Name:
CUMMING
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30041-7931
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-292-9982
Provider Business Practice Location Address Fax Number:
470-297-3347
Provider Enumeration Date:
05/06/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , with the licence number:  23639 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207P00000X , with the licence number: 047251 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000823292H , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: G47251 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".