MEDICARE: CAROLINE A KENNEDY PA-C

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	363A00000X	Physician Assistant	11059	GA

General Provider Information

NPI Number	:	1467181974
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLINE A KENNEDY PA-C

Provider Business Mailing Address
First Line	:	900 TOWNE LAKE PKWY STE 300
Second Line	:
City	:	WOODSTOCK
State	:	GA
Zip	:	30189-1604
Country	:	US
Telephone Number	:	770-874-2765
Fax Number	:	678-766-1914

Provider Business Practice Location Address
First Line	:	550 PEACHTREE ST NE STE 1700
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30308-2262
Country	:	US
Telephone Number	:	404-881-9727
Fax Number	:	404-881-9727

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

Provider Enumeration Date	:	06/09/2022
Last Update Date	:	10/28/2025

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