1457433138 NPI number — DR. KENNETH EDWIN FLEISHMAN M.D.

Table of content: DR. KENNETH EDWIN FLEISHMAN M.D. (NPI 1457433138)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457433138 NPI number — DR. KENNETH EDWIN FLEISHMAN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FLEISHMAN
Provider First Name:
KENNETH
Provider Middle Name:
EDWIN
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:
1457433138
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/12/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
934 BRIARCLIFF RD NE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30306-2618
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-888-6028
Provider Business Mailing Address Fax Number:
404-872-5088

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
711 EXECUTIVE PL
Provider Second Line Business Practice Location Address:
3RD FLOOR
Provider Business Practice Location Address City Name:
FAYETTEVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28305-5193
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-615-3700
Provider Business Practice Location Address Fax Number:
910-615-3798
Provider Enumeration Date:
10/20/2006

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: 2084P0800X , with the licence number:  2014-00756 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0804X , with the licence number: 2014-00756 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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