Basic Information
| Provider Information | |||||||||
| NPI: | 1174510598 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KRESS | ||||||||
| FirstName: | KENNETH | ||||||||
| MiddleName: | J. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 3400 OLD MILTON PKWY STE C290 | ||||||||
| Address2: | |||||||||
| City: | ALPHARETTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300056491 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7706674343 | ||||||||
| FaxNumber: | 7707720937 | ||||||||
| Practice Location | |||||||||
| Address1: | 3400 OLD MILTON PKWY STE C290 | ||||||||
| Address2: | |||||||||
| City: | ALPHARETTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300056491 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7706674343 | ||||||||
| FaxNumber: | 7707720937 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/30/2005 | ||||||||
| LastUpdateDate: | 09/14/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/14/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 032768 | GA | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 003161408F | 05 | GA | MEDICAID | 003161408E | 05 | GA | MEDICAID | 003161408G | 05 | GA | MEDICAID |