1598945552 NPI number — WILLIAM KEHNE MOELLER, MD, PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598945552 NPI number — WILLIAM KEHNE MOELLER, MD, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WILLIAM KEHNE MOELLER, MD, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1598945552
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1800 TREE LN
Provider Second Line Business Mailing Address:
SUITE 140
Provider Business Mailing Address City Name:
SNELLVILLE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30078-2016
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-344-4944
Provider Business Mailing Address Fax Number:
678-344-4947

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1800 TREE LN
Provider Second Line Business Practice Location Address:
SUITE 140
Provider Business Practice Location Address City Name:
SNELLVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30078-2016
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-344-4944
Provider Business Practice Location Address Fax Number:
678-344-4947
Provider Enumeration Date:
11/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MOELLER
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
KEHNE
Authorized Official Title or Position:
PRESIDENT/OWNER
Authorized Official Telephone Number:
678-344-4944

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , 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: GRP4367 . This is a "MEDICARE GROUP" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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