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General NPI Number Information
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NPI Number | 1548463185
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Entity Type | Organization
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Legal Business Name | MCKENNEY MEDICAL GROUP, PLLC
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Dates
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Enumeration Date | 06/11/2007
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 6712A S QUAY RD
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City | SUFFOLK
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State | VA
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Zip | 23437-8697
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Country | US
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Telephone | 757-657-9595
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Fax | 757-657-9950
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Provider Business Mailing Address
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Address Line | 6712A S QUAY RD
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City | SUFFOLK
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State | VA
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Zip | 23437-8697
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Country | US
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Telephone | 757-657-9595
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Fax | 757-657-9950
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Authorized Official
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Title or Position | OWNER
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Name | DR. JULIAN DEW MCKENNEY JR.
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Credential | D.O.
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Telephone | 757-657-9595
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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 | 0102037167
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License Number State | VA
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