Provider Demographics
NPI:1467491019
Name:KENNEDY, ANDREW SCOTT (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:SCOTT
Last Name:KENNEDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 742276
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-2276
Mailing Address - Country:US
Mailing Address - Phone:615-533-2441
Mailing Address - Fax:866-716-8706
Practice Address - Street 1:2410 PATTERSON ST
Practice Address - Street 2:BASEMENT LEVEL
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1551
Practice Address - Country:US
Practice Address - Phone:615-342-4850
Practice Address - Fax:615-342-4901
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC95-001172085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCB6753OtherMEDCOST
NC92-0007149OtherRAILROAD MEDICARE
NC178300OtherWELLPATH
NC24-00084OtherUNITED HEALTHCARE
NC131HYOtherBLUECROSS BLUESHIELD
NC92-0007149OtherRAILROAD MEDICARE
NC178300OtherWELLPATH
G21415Medicare UPIN