Provider Demographics
NPI:1750069530
Name:KENDALL, AUDRA T
Entity type:Individual
Prefix:MS
First Name:AUDRA
Middle Name:T
Last Name:KENDALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4027 MCCLURE DR APT 15A
Mailing Address - Street 2:
Mailing Address - City:OAKWOOD
Mailing Address - State:GA
Mailing Address - Zip Code:30566-3211
Mailing Address - Country:US
Mailing Address - Phone:678-943-6411
Mailing Address - Fax:
Practice Address - Street 1:4027 MCCLURE DR
Practice Address - Street 2:
Practice Address - City:OAKWOOD
Practice Address - State:GA
Practice Address - Zip Code:30566-3211
Practice Address - Country:US
Practice Address - Phone:678-943-6411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle