Healthcare Provider Details

I. General information

NPI: 1932150729
Provider Name (Legal Business Name): TODD E. KINNEBREW MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 10/22/2025
Certification Date: 10/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 MARGIE DR
WARNER ROBINS GA
31088-7818
US

IV. Provider business mailing address

301 MARGIE DR
WARNER ROBINS GA
31088-7818
US

V. Phone/Fax

Practice location:
  • Phone: 478-971-1153
  • Fax: 478-971-1171
Mailing address:
  • Phone: 478-971-1153
  • Fax: 478-971-1171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number37009
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: