Provider Demographics
NPI:1952382863
Name:COLE, KENDRA A (MD)
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:A
Last Name:COLE
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 1:3525 HOLCOMB BRIDGE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CORNERS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-2725
Mailing Address - Country:US
Mailing Address - Phone:678-417-6900
Mailing Address - Fax:770-418-8580
Practice Address - Street 1:3525 HOLCOMB BRIDGE RD STE 100
Practice Address - Street 2:
Practice Address - City:PEACHTREE CORNERS
Practice Address - State:GA
Practice Address - Zip Code:30092-2725
Practice Address - Country:US
Practice Address - Phone:678-417-6900
Practice Address - Fax:770-418-8580
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA030406174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAE72971Medicare UPIN
GA07BBSMKMedicare PIN