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NPI Code Detail

MEDICARE: KENNEDI MINCEY

MEDICARE: KENNEDI MINCEY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior TechnicianRBT-26-517823

General Provider Information

NPI Number : 1124975750
Entity Type Code : Individual
Provider Name (Legal Business Name) : KENNEDI MINCEY
Provider Business Mailing Address
First Line : PO BOX 931142
Second Line :
City : ATLANTA
State : GA
Zip : 31193-1142
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1400 BROWNING RD STE 195
Second Line :
City : COLUMBIA
State : SC
Zip : 29210-6941
Country : US
Telephone Number : 803-999-3752
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/12/2026
Last Update Date : 03/12/2026

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Directions to “ KENNEDI MINCEY ” Practice Location

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