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General NPI Number Information
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NPI Number | 1013148626
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Entity Type | Individual
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Provider Name | SHEILA KENNEDY MD
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Gender | Female
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Dates
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Enumeration Date | 07/30/2009
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Last Update Date | 04/09/2015
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Provider Practice Location Address
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Address Line | 1430 FIVE FORKS TRICKUM RD ST 220
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City | LAWRENCEVILLE
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State | GA
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Zip | 30044-8182
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Country | US
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Telephone | 678-578-4983
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Fax | 678-578-4988
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Provider Business Mailing Address
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Address Line | 2491 PANOLA RD
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City | LITHONIA
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State | GA
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Zip | 30058-4831
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Country | US
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Telephone | 678-205-4999
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Fax | 678-205-4969
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 68227
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State | NJ
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