Provider Demographics
NPI:1477583813
Name:KENNEDY, MARGARET ANN (FNP-C)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:ANN
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4356 RIVERSIDE LN SW
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-4553
Mailing Address - Country:US
Mailing Address - Phone:770-972-7134
Mailing Address - Fax:
Practice Address - Street 1:ATLANTA VAMC
Practice Address - Street 2:1670 CLAIRMONT ROAD
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033
Practice Address - Country:US
Practice Address - Phone:404-321-6111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN040722207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine