Provider Demographics
NPI:1164426136
Name:KENDRICK, JOHN P (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:P
Last Name:KENDRICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3527 N VALDOSTA RD
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-1068
Mailing Address - Country:US
Mailing Address - Phone:229-247-2290
Mailing Address - Fax:229-244-2626
Practice Address - Street 1:3527 N VALDOSTA RD
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-1068
Practice Address - Country:US
Practice Address - Phone:229-247-2290
Practice Address - Fax:229-244-2626
Is Sole Proprietor?:No
Enumeration Date:2005-06-08
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA026883207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL375260700Medicaid
GA00327973BMedicaid
20BDCMCMedicare ID - Type Unspecified
GA00327973BMedicaid
FL375260700Medicaid