MEDICARE: DR. EMBRY MAYES KENDRICK OD

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	152W00000X	Optometrist	1222	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669447249
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EMBRY MAYES KENDRICK OD

Provider Business Mailing Address
First Line	:	PO BOX 490
Second Line	:
City	:	PEMBROKE
State	:	GA
Zip	:	31321-0490
Country	:	US
Telephone Number	:	912-225-1929
Fax Number	:	912-225-1929

Provider Business Practice Location Address
First Line	:	1962 OLD GROVELAND RD
Second Line	:
City	:	PEMBROKE
State	:	GA
Zip	:	31321-3340
Country	:	US
Telephone Number	:	912-225-1929
Fax Number	:	912-225-1929

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

Provider Enumeration Date	:	02/17/2006
Last Update Date	:	03/29/2016

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