Healthcare Provider Details

I. General information

NPI: 1710947403
Provider Name (Legal Business Name): DONALD FRANKLIN KENNEDY JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2006
Last Update Date: 03/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 MEMORIAL DRIVE
REIDSVILLE GA
30453
US

IV. Provider business mailing address

460 MALL BLVD STE B
SAVANNAH GA
31406-4801
US

V. Phone/Fax

Practice location:
  • Phone: 912-557-6224
  • Fax: 912-557-3198
Mailing address:
  • Phone: 912-644-5300
  • Fax: 912-644-5260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number24278
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number024278
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: