Provider Demographics
NPI:1679623086
Name:TURNER, M. KEVIN (PH D)
Entity type:Individual
Prefix:DR
First Name:M.
Middle Name:KEVIN
Last Name:TURNER
Suffix:
Gender:M
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 ROSSMORE PL
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-5769
Mailing Address - Country:US
Mailing Address - Phone:706-364-7165
Mailing Address - Fax:706-869-7600
Practice Address - Street 1:103 ROSSMORE PL
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-5769
Practice Address - Country:US
Practice Address - Phone:706-364-7165
Practice Address - Fax:706-869-7600
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY001589103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA68BBGNBMedicare ID - Type Unspecified
GAS21522Medicare UPIN