Provider Demographics
NPI:1780698985
Name:KENNEDY, JAMES JOSEPH (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:JOSEPH
Last Name:KENNEDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:J
Other - Middle Name:JOSEPH
Other - Last Name:KENNEDY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 10907
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37939-0907
Mailing Address - Country:US
Mailing Address - Phone:865-588-4044
Mailing Address - Fax:865-588-6990
Practice Address - Street 1:6906 KINGSTON PIKE
Practice Address - Street 2:SUITE 200
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-5704
Practice Address - Country:US
Practice Address - Phone:865-588-4044
Practice Address - Fax:865-588-6990
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD020718174400000X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3871294Medicaid
TN3054105Medicaid
TNE51002Medicare UPIN