Provider Demographics
NPI:1457676629
Name:KEN DENNY PC
Entity Type:Organization
Organization Name:KEN DENNY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:DENNY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-231-9403
Mailing Address - Street 1:22 W BRYAN ST
Mailing Address - Street 2:#134
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31401-2604
Mailing Address - Country:US
Mailing Address - Phone:912-231-9403
Mailing Address - Fax:912-231-2312
Practice Address - Street 1:7 DRAYTON ST
Practice Address - Street 2:SUITE 308
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31401-2723
Practice Address - Country:US
Practice Address - Phone:912-231-9403
Practice Address - Fax:912-231-2312
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-31
Last Update Date:2010-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
GA001654251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA219024156AMedicaid