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General NPI Number Information
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NPI Number | 1336276815
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Entity Type | Organization
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Legal Business Name | KENDRICK FAMILY PRACTICE
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Dates
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Enumeration Date | 02/28/2007
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Last Update Date | 04/16/2013
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Provider Practice Location Address
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Address Line | 5900 HILLANDALE DRIVE SUITE 300
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City | LITHONIA
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State | GA
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Zip | 30058
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Country | US
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Telephone | 770-987-2155
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Fax | 770-323-2675
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Provider Business Mailing Address
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Address Line | 5900 HILLANDALE DRIVE SUITE 300
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City | LITHONIA
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State | GA
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Zip | 30058
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Country | US
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Telephone | 770-987-2155
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Fax | 770-323-2675
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JANET L BIVENS
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Credential | M.D.
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Telephone | 770-987-2155
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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 | 032410
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License Number State | GA
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