Healthcare Provider Details

I. General information

NPI: 1699772228
Provider Name (Legal Business Name): J LEX KENERLY III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2005
Last Update Date: 06/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 PROFESSIONAL CT
JESUP GA
31545-0044
US

IV. Provider business mailing address

PO BOX 1334
JESUP GA
31598-1334
US

V. Phone/Fax

Practice location:
  • Phone: 912-427-0800
  • Fax: 912-427-6029
Mailing address:
  • Phone: 912-427-0800
  • Fax: 912-427-6029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number030633
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: