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General NPI Number Information
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NPI Number | 1942225313
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Entity Type | Individual
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Provider Name | RICHARD THOMAS KENNEDY M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/13/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 169 NORTH SECOND AVE
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City | HARTFORD
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State | AL
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Zip | 36344
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Country | US
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Telephone | 334-588-2084
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Fax | 334-588-2168
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Provider Business Mailing Address
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Address Line | 1803 BETHLEHEM RD
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City | MIDLAND CITY
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State | AL
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Zip | 36350-6013
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Country | US
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Telephone | 334-983-1864
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 00008459
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License Number State | AL
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