Basic Information
| Provider Information | |||||||||
| NPI: | 1720057102 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KAY | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | BRIAN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 250 MARTIN LUTHER KING JR BLVD | ||||||||
| Address2: | |||||||||
| City: | MACON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 312013490 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4783012362 | ||||||||
| FaxNumber: | 4783012272 | ||||||||
| Practice Location | |||||||||
| Address1: | 138 N COLLEGE ST | ||||||||
| Address2: | |||||||||
| City: | HAMILTON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 318116031 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7622670309 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/16/2006 | ||||||||
| LastUpdateDate: | 02/03/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/01/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | 47780 | GA | Y | Allopathic & Osteopathic Physicians | General Practice | 207V00000X | 047780 | GA | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 000842597K | 05 | GA | MEDICAID | 00084257K | 05 | GA | MEDICAID | 47780 | 05 | GA | MEDICAID | 000842597I | 05 | GA | MEDICAID | 000842597G | 05 | GA | MEDICAID | 000842597H | 05 | GA | MEDICAID |