Provider Demographics
NPI:1336276815
Name:KENDRICK FAMILY PRACTICE
Entity Type:Organization
Organization Name:KENDRICK FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JANET
Authorized Official - Middle Name:L
Authorized Official - Last Name:BIVENS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-987-2155
Mailing Address - Street 1:5900 HILLANDALE DRIVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30058
Mailing Address - Country:US
Mailing Address - Phone:770-987-2155
Mailing Address - Fax:770-323-2675
Practice Address - Street 1:5900 HILLANDALE DRIVE
Practice Address - Street 2:SUITE 300
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30058
Practice Address - Country:US
Practice Address - Phone:770-987-2155
Practice Address - Fax:770-323-2675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA032410207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00416138AMedicaid
GAD16963Medicare UPIN
GA00416138AMedicaid