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General NPI Number Information
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NPI Number | 1427346469
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Entity Type | Organization
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Legal Business Name | EMERALD COAST RHEUMATOLOGY LLC
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Dates
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Enumeration Date | 07/12/2011
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Last Update Date | 01/30/2026
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Provider Practice Location Address
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Address Line | 3890 JENKS AVE
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City | LYNN HAVEN
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State | FL
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Zip | 32444-4701
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Country | US
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Telephone | 850-215-6400
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Fax | 850-215-4440
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Provider Business Mailing Address
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Address Line | 3890 JENKS AVE
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City | LYNN HAVEN
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State | FL
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Zip | 32444-4701
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Country | US
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Telephone | 850-215-6400
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Fax | 850-215-4440
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Authorized Official
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Title or Position | CEO / MEDICAL DIRECTOR
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Name | DR. AYMEN A. KENAWY
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Credential | M.D.
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Telephone | 850-215-6400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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Taxonomy #2
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Taxonomy Code | 207QS1201X
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Taxonomy Name | Sleep Medicine (Family Medicine) Physician
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Taxonomy #3
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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Taxonomy #4
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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Taxonomy #5
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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Taxonomy #6
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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