Provider Demographics
NPI:1558396838
Name:KENNEDY, ALBERT FRANKLIN (MD)
Entity Type:Individual
Prefix:
First Name:ALBERT
Middle Name:FRANKLIN
Last Name:KENNEDY
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 1:6215 HUMPHREYS BLVD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-2367
Mailing Address - Country:US
Mailing Address - Phone:901-628-0630
Mailing Address - Fax:901-682-0635
Practice Address - Street 1:6215 HUMPHREYS BLVD
Practice Address - Street 2:SUITE 500
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-2367
Practice Address - Country:US
Practice Address - Phone:901-628-0630
Practice Address - Fax:901-682-0635
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN18523174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNE43153Medicare UPIN
TN3052723Medicare ID - Type Unspecified