Provider Demographics
NPI:1699880740
Name:BYERS, KENNETH W
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:W
Last Name:BYERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 HENDERSON DR STE 409
Mailing Address - Street 2:
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30120-3723
Mailing Address - Country:US
Mailing Address - Phone:770-387-3450
Mailing Address - Fax:770-387-3425
Practice Address - Street 1:650 HENDERSON DR STE 409
Practice Address - Street 2:
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120-3723
Practice Address - Country:US
Practice Address - Phone:770-387-3450
Practice Address - Fax:770-387-3425
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2009-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA020969207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D31323Medicare UPIN