Jensen, Kevin Lee

Jensen, Kevin Lee is an individual health care provider with primary practice located at 743 Old Norcross Rd , Lawrenceville GA 30046-4317. He recently has only one registered license in Allopathic & Osteopathic Physicians / Surgery, which is considered as his primary health care specialty. Jensen, Kevin Lee can be contacted via phone (770) 513-1763.

Contact Information

Primary practice address
743 Old Norcross Rd Lawrenceville GA 30046-4317
Phone: (770) 513-1763
Fax: (770) 513-2199
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Surgery 208600000X 28794 Georgia

Profile Details

NPI number 1497855779
LBN Legal business name Jensen, Kevin Lee
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 25th, 2006
Last updated Apr 10th, 2014 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1497855779 NPPES
Georgia MEDICAID 00435058D

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