Healthcare Provider Details

I. General information

NPI: 1588528194
Provider Name (Legal Business Name): KERRY KERNS LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2625 SANDY PLAINS RD STE 104
MARIETTA GA
30066-4290
US

IV. Provider business mailing address

1 HUNTINGTON RD STE 703
ATHENS GA
30606-7214
US

V. Phone/Fax

Practice location:
  • Phone: 706-425-8900
  • Fax:
Mailing address:
  • Phone: 706-425-8900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberMSW012618
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: