Basic Information
| Provider Information | |||||||||
| NPI: | 1053598151 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BRIAN K. NADOLNE, MD, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1230 JOHNSON FERRY PL STE H20 | ||||||||
| Address2: | |||||||||
| City: | MARIETTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300682057 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7705090017 | ||||||||
| FaxNumber: | 7709717818 | ||||||||
| Practice Location | |||||||||
| Address1: | 1230 JOHNSON FERRY PL STE H20 | ||||||||
| Address2: | |||||||||
| City: | MARIETTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300682057 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7705090017 | ||||||||
| FaxNumber: | 7709717818 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/31/2008 | ||||||||
| LastUpdateDate: | 04/23/2008 | ||||||||
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| AuthorizedOfficialLastName: | NADOLNE | ||||||||
| AuthorizedOfficialFirstName: | BRIAN | ||||||||
| AuthorizedOfficialMiddleName: | KEITH | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7705090017 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 040748 | GA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 7394560 | 01 | GA | AETNA | OTHER | 00739505E | 05 | GA | MEDICAID | P00243653 | 01 | GA | RAILROAD MEDICARE | OTHER | 1073451 | 01 | GA | COVENTRY HEALTHCARE | OTHER | 176614008 | 01 | GA | UNITED HEALTHCARE | OTHER | 52543664 | 01 | GA | B/C B/S OF GEORGIA | OTHER | 5656896 | 01 | GA | CIGNA | OTHER |