Healthcare Provider Details

I. General information

NPI: 1417236365
Provider Name (Legal Business Name): WILLIAM E. KENNEDY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2011
Last Update Date: 08/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 WEST MAIN ST.
JONESBOROUGH TN
37659-1227
US

IV. Provider business mailing address

115 WEST MAIN ST.
JONESBOROUGH TN
37659-1227
US

V. Phone/Fax

Practice location:
  • Phone: 423-753-3161
  • Fax: 723-753-0193
Mailing address:
  • Phone: 423-753-3161
  • Fax: 723-753-0193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code202C00000X
TaxonomyIndependent Medical Examiner Physician
License Number05-01630
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD0000007613
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: