Healthcare Provider Details

I. General information

NPI: 1013784602
Provider Name (Legal Business Name): KYNDALL DENISE GROGAN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KYNDALL DENISE STRICKLAND PA

II. Dates (important events)

Enumeration Date: 12/05/2023
Last Update Date: 11/03/2025
Certification Date: 11/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 10TH AVE STE 211
COLUMBUS GA
31901-3604
US

IV. Provider business mailing address

PO BOX 370
FORTSON GA
31808-0370
US

V. Phone/Fax

Practice location:
  • Phone: 706-507-0220
  • Fax:
Mailing address:
  • Phone: 706-570-0220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number12137
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: