Provider Demographics
NPI:1184055899
Name:MCDONALD, CYNTHIA KENNEDY (DPH)
Entity type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:KENNEDY
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 CHADWICK FARMS DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37334-6081
Mailing Address - Country:US
Mailing Address - Phone:931-625-2040
Mailing Address - Fax:
Practice Address - Street 1:1201 DINAH SHORE BLVD
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37398-1107
Practice Address - Country:US
Practice Address - Phone:931-967-2777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-05
Last Update Date:2013-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7368183500000X
AL11708183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist