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General NPI Number Information
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NPI Number | 1588835409
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Entity Type | Organization
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Legal Business Name | DONALD F KENNEDY JR MD PC
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Dates
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Enumeration Date | 03/19/2008
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Last Update Date | 03/19/2008
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Provider Practice Location Address
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Address Line | 825 S 1ST ST
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City | JESUP
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State | GA
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Zip | 31545-0209
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Country | US
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Telephone | 912-427-7500
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Fax | 912-427-0200
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Provider Business Mailing Address
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Address Line | PO BOX 563
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City | JESUP
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State | GA
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Zip | 31598-0563
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Country | US
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Telephone | 912-427-7500
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Fax | 912-427-0200
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Authorized Official
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Title or Position | MEDICAL DOCTOR
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Name | DR. DONALD F KENNEDY II
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Credential | MD
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Telephone | 912-427-7500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 24278
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License Number State | GA
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