Healthcare Provider Details

I. General information

NPI: 1396232336
Provider Name (Legal Business Name): JAMES GLENN KENNIS III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2018
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

955 RIBAUT RD
BEAUFORT SC
29902-5454
US

IV. Provider business mailing address

955 RIBAUT RD
BEAUFORT SC
29902-5454
US

V. Phone/Fax

Practice location:
  • Phone: 843-522-5200
  • Fax:
Mailing address:
  • Phone: 843-522-5200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number52710
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberLL52710
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number0101276321
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: