Provider Demographics
NPI:1457732992
Name:BREWER, KENDALL STUART (MD)
Entity Type:Individual
Prefix:
First Name:KENDALL
Middle Name:STUART
Last Name:BREWER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 WEST 8TH STREET
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165-2723
Mailing Address - Country:US
Mailing Address - Phone:706-291-8702
Mailing Address - Fax:706-291-6514
Practice Address - Street 1:311 WEST 8TH STREET
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-2723
Practice Address - Country:US
Practice Address - Phone:706-291-8702
Practice Address - Fax:706-291-6514
Is Sole Proprietor?:No
Enumeration Date:2015-06-10
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA92954207ZC0500X, 207ZP0102X
ALMD.44534207ZC0500X, 207ZP0102X
OH35.138546207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003272587AMedicaid