MEDICARE: KENNEDY HOLMES

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
1	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1235096595
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNEDY HOLMES

Provider Business Mailing Address
First Line	:	20 OAK HILL BLVD STE 300
Second Line	:
City	:	NEWNAN
State	:	GA
Zip	:	30265-2667
Country	:	US
Telephone Number	:	404-844-8632
Fax Number	:	855-817-2428

Provider Business Practice Location Address
First Line	:	20 OAK HILL BLVD STE 300
Second Line	:
City	:	NEWNAN
State	:	GA
Zip	:	30265-2667
Country	:	US
Telephone Number	:	404-844-8632
Fax Number	:	855-817-2428

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/08/2026
Last Update Date	:	01/08/2026

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