Healthcare Provider Details

I. General information

NPI: 1427211259
Provider Name (Legal Business Name): TYLER JAMES KENNING M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2008
Last Update Date: 04/10/2020
Certification Date: 04/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 PEACHTREE RD NE STE 645
ATLANTA GA
30309-1476
US

IV. Provider business mailing address

47 NEW SCOTLAND AVE MC-10
ALBANY NY
12208-3412
US

V. Phone/Fax

Practice location:
  • Phone: 404-605-2050
  • Fax:
Mailing address:
  • Phone: 518-262-5088
  • Fax: 518-262-5400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberMD442141
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number084087
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: