Provider Demographics
NPI:1871865980
Name:KENDRICK, WILLIAM RILEY JR (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:RILEY
Last Name:KENDRICK
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:WILLIAM
Other - Middle Name:RILEY
Other - Last Name:KENDRICK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3358 BENTBROOKE CV
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:TN
Mailing Address - Zip Code:38002-5746
Mailing Address - Country:US
Mailing Address - Phone:901-385-3906
Mailing Address - Fax:
Practice Address - Street 1:3358 BENTBROOKE CV
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:TN
Practice Address - Zip Code:38002-5746
Practice Address - Country:US
Practice Address - Phone:901-385-3906
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-04
Last Update Date:2012-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD7664174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist