Provider Demographics
NPI:1053598151
Name:BRIAN K. NADOLNE, MD, PC
Entity type:Organization
Organization Name:BRIAN K. NADOLNE, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:NADOLNE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-509-0017
Mailing Address - Street 1:1230 JOHNSON FERRY PL STE H20
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30068-2057
Mailing Address - Country:US
Mailing Address - Phone:770-509-0017
Mailing Address - Fax:770-971-7818
Practice Address - Street 1:1230 JOHNSON FERRY PL STE H20
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30068-2057
Practice Address - Country:US
Practice Address - Phone:770-509-0017
Practice Address - Fax:770-971-7818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-31
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA040748207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA7394560OtherAETNA
GA00739505EMedicaid
GAP00243653OtherRAILROAD MEDICARE
GA1073451OtherCOVENTRY HEALTHCARE
GA176614008OtherUNITED HEALTHCARE
GA52543664OtherB/C B/S OF GEORGIA
GA5656896OtherCIGNA
GA5656896OtherCIGNA
GA176614008OtherUNITED HEALTHCARE