Provider Demographics
NPI:1093790297
Name:KENNEDY, DENIS T (MD)
Entity Type:Individual
Prefix:DR
First Name:DENIS
Middle Name:T
Last Name:KENNEDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:DENIS
Other - Middle Name:
Other - Last Name:KENNEDY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2525 DESALES AVE
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404-1161
Mailing Address - Country:US
Mailing Address - Phone:423-495-2620
Mailing Address - Fax:423-495-2625
Practice Address - Street 1:2525 DESALES AVE
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-1161
Practice Address - Country:US
Practice Address - Phone:423-495-2620
Practice Address - Fax:423-495-2625
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN271692084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
3087547OtherBLUE CROSS BLUE SHIELD
TN3099208Medicaid
TN3099208Medicare PIN
TN3099208Medicaid