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General NPI Number Information
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NPI Number | 1790059939
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Entity Type | Organization
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Legal Business Name | RICHARD T KENNEDY MD LLC
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Dates
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Enumeration Date | 03/06/2012
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Last Update Date | 03/06/2012
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Provider Practice Location Address
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Address Line | 2115 W MAIN ST
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City | DOTHAN
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State | AL
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Zip | 36301-1289
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Country | US
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Telephone | 334-793-6556
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Fax | 334-793-2583
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Provider Business Mailing Address
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Address Line | 2115 W MAIN ST
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City | DOTHAN
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State | AL
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Zip | 36301-1289
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Country | US
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Telephone | 334-793-6556
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Fax | 334-793-2583
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Authorized Official
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Title or Position | OWNER
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Name | RICHARD T KENNEDY
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Credential | M.D.
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Telephone | 334-793-6556
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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 | 8459
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License Number State | AL
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