Provider Demographics
NPI:1588787162
Name:BARNGROVER, KENNETH (D O)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:
Last Name:BARNGROVER
Suffix:
Gender:
Credentials:D O
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5669 WHITESVILLE RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-9054
Mailing Address - Country:US
Mailing Address - Phone:706-571-7246
Mailing Address - Fax:706-571-8820
Practice Address - Street 1:5669 WHITESVILLE RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-9054
Practice Address - Country:US
Practice Address - Phone:706-571-7246
Practice Address - Fax:706-571-8820
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA027027332B00000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000296777EMedicaid
C71138Medicare UPIN
GA000296777EMedicaid