Provider Demographics
NPI:1780095851
Name:KENNEDY, JOSHUA R (DO)
Entity type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:R
Last Name:KENNEDY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:JOSH
Other - Middle Name:R
Other - Last Name:KENNEDY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:77 WEAVER RD STE B
Mailing Address - Street 2:
Mailing Address - City:BLAIRSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30512-3136
Mailing Address - Country:US
Mailing Address - Phone:706-745-6165
Mailing Address - Fax:706-745-0836
Practice Address - Street 1:77 WEAVER RD STE B
Practice Address - Street 2:
Practice Address - City:BLAIRSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30512
Practice Address - Country:US
Practice Address - Phone:706-745-6165
Practice Address - Fax:706-745-0836
Is Sole Proprietor?:No
Enumeration Date:2014-05-12
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA78056208000000X, 2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics