Healthcare Provider Details

I. General information

NPI: 1427346469
Provider Name (Legal Business Name): EMERALD COAST RHEUMATOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2011
Last Update Date: 01/30/2026
Certification Date: 01/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3890 JENKS AVE
LYNN HAVEN FL
32444-4701
US

IV. Provider business mailing address

3890 JENKS AVE
LYNN HAVEN FL
32444-4701
US

V. Phone/Fax

Practice location:
  • Phone: 850-215-6400
  • Fax: 850-215-4440
Mailing address:
  • Phone: 850-215-6400
  • Fax: 850-215-4440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207QS1201X
TaxonomySleep Medicine (Family Medicine) Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: DR. AYMEN A. KENAWY
Title or Position: CEO / MEDICAL DIRECTOR
Credential: M.D.
Phone: 850-215-6400