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General NPI Number Information
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NPI Number | 1033979828
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Entity Type | Individual
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Provider Name | DANNA-GRACE WAGERS KENNEDY PA-C
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Gender | Female
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Dates
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Enumeration Date | 03/20/2024
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Last Update Date | 12/29/2025
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Provider Practice Location Address
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Address Line | 2200 MEDICAL CENTER BLVD STE 400
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-7769
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Country | US
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Telephone | 770-758-7482
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Fax |
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Provider Business Mailing Address
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Address Line | 142 BRIX DR
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City | LOCUST GROVE
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State | GA
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Zip | 30248-2643
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Country | US
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Telephone | 770-842-9133
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Fax |
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 12232
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License Number State | GA
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