Healthcare Provider Details

I. General information

NPI: 1528075793
Provider Name (Legal Business Name): KENNETH ALBERT ANDERSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 02/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6605 ABERCORN ST STE 108
SAVANNAH GA
31405-5896
US

IV. Provider business mailing address

255 WEST MICHIGAN AVENUE PO BOX 1123
JACKSON MI
49201-1123
US

V. Phone/Fax

Practice location:
  • Phone: 912-355-7214
  • Fax: 517-787-7365
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME92106
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number19091
License Number StateSC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: