Healthcare Provider Details

I. General information

NPI: 1467457010
Provider Name (Legal Business Name): KENNETH WENDELL HEALEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2005
Last Update Date: 06/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 E LAMAR ST
AMERICUS GA
31709-3737
US

IV. Provider business mailing address

603 E LAMAR ST
AMERICUS GA
31709-3737
US

V. Phone/Fax

Practice location:
  • Phone: 229-928-3444
  • Fax: 229-928-3446
Mailing address:
  • Phone: 229-928-3444
  • Fax: 229-928-3446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number024689
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: