Provider Demographics
NPI:1013385467
Name:KENNY R SINERVO MD
Entity Type:Organization
Organization Name:KENNY R SINERVO MD
Other - Org Name:CENTER FOR ENDOMETRIOSIS CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNY
Authorized Official - Middle Name:R
Authorized Official - Last Name:SINERVO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-913-0001
Mailing Address - Street 1:1140 HAMMOND DR
Mailing Address - Street 2:BLDG F S-6220
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-5338
Mailing Address - Country:US
Mailing Address - Phone:770-913-0001
Mailing Address - Fax:770-913-0005
Practice Address - Street 1:1140 HAMMOND DR
Practice Address - Street 2:BLDG F S-6220
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-5338
Practice Address - Country:US
Practice Address - Phone:770-913-0001
Practice Address - Fax:770-913-0005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-02
Last Update Date:2015-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1526905207VF0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyFemale Pelvic Medicine and Reconstructive SurgeryGroup - Multi-Specialty