Basic Information
| Provider Information | |||||||||
| NPI: | 1407805872 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NADOLNE | ||||||||
| FirstName: | BRIAN | ||||||||
| MiddleName: | KEITH | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1230 JOHNSON FERRY PL | ||||||||
| Address2: | STE B-10 | ||||||||
| City: | MARIETTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300682048 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7705090017 | ||||||||
| FaxNumber: | 7709717818 | ||||||||
| Practice Location | |||||||||
| Address1: | 1121 JOHNSON FERRY RD STE 320 | ||||||||
| Address2: | |||||||||
| City: | MARIETTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300685404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7705090017 | ||||||||
| FaxNumber: | 7709717818 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2006 | ||||||||
| LastUpdateDate: | 04/26/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 040748 | GA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 5656896 | 01 | GA | CIGNA | OTHER | 7394560 | 01 | GA | AETNA | OTHER | 000739505E | 05 | GA | MEDICAID | 52543664 | 01 | GA | B/C B/S OF GEORGIA | OTHER | 1073451 | 01 | GA | COVENTRY HEALTHCARE | OTHER | 176614008 | 01 | GA | UNITED HEALTHCARE | OTHER | P00243653 | 01 | GA | RAILROAD MEDICARE | OTHER |