Provider Demographics
NPI:1538260955
Name:ARTHUR, KENNETH LEE (RPH)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:LEE
Last Name:ARTHUR
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3011 HIGHWAY 2 W
Mailing Address - Street 2:
Mailing Address - City:CRANDALL
Mailing Address - State:GA
Mailing Address - Zip Code:30711-5162
Mailing Address - Country:US
Mailing Address - Phone:706-695-0184
Mailing Address - Fax:
Practice Address - Street 1:1710 CLEVELAND HWY
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30721-8313
Practice Address - Country:US
Practice Address - Phone:706-259-9787
Practice Address - Fax:706-259-9174
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH013139183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0557430001Medicare ID - Type Unspecified