Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204F00000X | Transplant Surgeon | 82597 | GA |
NPI | 1265759963 |
---|---|
Provider Name | Clark David Kensinger |
First Address | Atlanta, GA 30309-1281 |
Second Address | Atlanta, GA 30309-1281 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/04/2010 |
Last Update Date | 23/09/2019 |