Provider Demographics
NPI:1588835409
Name:DONALD F KENNEDY JR MD PC
Entity Type:Organization
Organization Name:DONALD F KENNEDY JR MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:F
Authorized Official - Last Name:KENNEDY
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:912-427-7500
Mailing Address - Street 1:PO BOX 563
Mailing Address - Street 2:
Mailing Address - City:JESUP
Mailing Address - State:GA
Mailing Address - Zip Code:31598-0563
Mailing Address - Country:US
Mailing Address - Phone:912-427-7500
Mailing Address - Fax:912-427-0200
Practice Address - Street 1:825 S 1ST ST
Practice Address - Street 2:
Practice Address - City:JESUP
Practice Address - State:GA
Practice Address - Zip Code:31545-0209
Practice Address - Country:US
Practice Address - Phone:912-427-7500
Practice Address - Fax:912-427-0200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-19
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA24278174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP7493Medicare PIN