Provider Demographics
NPI:1710947403
Name:KENNEDY, DONALD FRANKLIN JR (MD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:FRANKLIN
Last Name:KENNEDY
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:460 MALL BLVD
Mailing Address - Street 2:STE B
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-4801
Mailing Address - Country:US
Mailing Address - Phone:912-644-5300
Mailing Address - Fax:912-644-5260
Practice Address - Street 1:131 MEMORIAL DRIVE
Practice Address - Street 2:
Practice Address - City:REIDSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30453
Practice Address - Country:US
Practice Address - Phone:912-557-6224
Practice Address - Fax:912-557-3198
Is Sole Proprietor?:No
Enumeration Date:2006-03-25
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA24278174400000X
GA024278208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000279408BMedicaid
GAD40340Medicare UPIN
GAD403040Medicare UPIN
GAGRP7493Medicare ID - Type Unspecified