Provider Demographics
NPI:1508936964
Name:SINERVO, KENNY R (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNY
Middle Name:R
Last Name:SINERVO
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Gender:M
Credentials:MD
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Mailing Address - Street 1:6105 PEACHTREE DUNWOODY RD
Mailing Address - Street 2:BLDG B; SUITE 230
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328
Mailing Address - Country:US
Mailing Address - Phone:770-913-0001
Mailing Address - Fax:770-913-0005
Practice Address - Street 1:6105 PEACHTREE DUNWOODY RD
Practice Address - Street 2:BLDG. B; SUITE 230
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328
Practice Address - Country:US
Practice Address - Phone:770-913-0001
Practice Address - Fax:770-913-0005
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2016-10-14
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Provider Licenses
StateLicense IDTaxonomies
GA48574207VF0040X, 207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyFemale Pelvic Medicine and Reconstructive Surgery
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAH84895Medicare UPIN
GAH84895Medicare UPIN