Provider Demographics
NPI:1770517674
Name:GAMBLE-WEBB, KENDRA VANICE (MD)
Entity type:Individual
Prefix:DR
First Name:KENDRA
Middle Name:VANICE
Last Name:GAMBLE-WEBB
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KENDRA
Other - Middle Name:VANICE
Other - Last Name:GAMBLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3869 HIGHWAY 81
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-3918
Mailing Address - Country:US
Mailing Address - Phone:770-466-3622
Mailing Address - Fax:770-466-3630
Practice Address - Street 1:3869 HIGHWAY 81
Practice Address - Street 2:
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052-3918
Practice Address - Country:US
Practice Address - Phone:770-466-3622
Practice Address - Fax:770-466-3630
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA057621207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA7967880OtherAETNA
GA710852709BMedicaid
GA710852709CMedicaid
GA710852709DMedicaid
GA52210269OtherBCBS
GA710852709AMedicaid
GA710852709DMedicaid
GA16BBDFFMedicare ID - Type Unspecified