Provider Demographics
NPI:1053318774
Name:HERMAN, HOWARD KENNETH (MD)
Entity type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:KENNETH
Last Name:HERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1240 HIGHWAY 54 W BLDG 700 STE 710
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-4565
Mailing Address - Country:US
Mailing Address - Phone:678-534-5922
Mailing Address - Fax:770-997-3827
Practice Address - Street 1:830 EAGLES LANDING PKWY STE 102
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-7366
Practice Address - Country:US
Practice Address - Phone:770-389-0000
Practice Address - Fax:770-389-0168
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA036777207YS0012X, 207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YS0012XAllopathic & Osteopathic PhysiciansOtolaryngologySleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000544387BMedicaid
GA40010665OtherRAILROAD MEDICARE
GA474095OtherAETNA
GA0379519OtherCIGNA
GA000544387CMedicaid
GA52414201OtherBCBS OF GEORGIA
GA000544387KMedicaid