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General NPI Number Information
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NPI Number | 1669262242
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Entity Type | Individual
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Provider Name | AMANDA LAUREN KENNEDY MS, RDN, LDN, CLC
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Gender | Female
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Dates
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Enumeration Date | 05/08/2025
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Last Update Date | 12/30/2025
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Provider Practice Location Address
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Address Line | 8735 DUNWOODY PL # 11324
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City | ATLANTA
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State | GA
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Zip | 30350-2995
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Country | US
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Telephone | 404-323-7436
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Fax |
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Provider Business Mailing Address
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Address Line | 1123 WILLOW TRCE
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City | GRAYSON
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State | GA
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Zip | 30017-1109
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Country | US
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Telephone |
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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 | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | LD006263
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License Number State | GA
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