Provider Demographics
NPI:1568414449
Name:MCPHERSON, KENNETH FRANCIS (PHD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:FRANCIS
Last Name:MCPHERSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3341
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30914-3341
Mailing Address - Country:US
Mailing Address - Phone:706-736-1812
Mailing Address - Fax:706-736-0878
Practice Address - Street 1:2610 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904-5347
Practice Address - Country:US
Practice Address - Phone:706-736-1812
Practice Address - Fax:706-736-0878
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1502103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPS0360OtherMEDICAID
SCPS0360OtherMEDICAID