MEDICARE: DR. KENDRA VANICE GAMBLE-WEBB M.D.

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	207V00000X	Obstetrics & Gynecology Physician	057621	GA

General Provider Information

NPI Number	:	1770517674
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENDRA VANICE GAMBLE-WEBB M.D.

Provider Business Mailing Address
First Line	:	3869 HIGHWAY 81
Second Line	:
City	:	LOGANVILLE
State	:	GA
Zip	:	30052-3918
Country	:	US
Telephone Number	:	770-466-3622
Fax Number	:	770-466-3630

Provider Business Practice Location Address
First Line	:	3869 HIGHWAY 81
Second Line	:
City	:	LOGANVILLE
State	:	GA
Zip	:	30052-3918
Country	:	US
Telephone Number	:	770-466-3622
Fax Number	:	770-466-3630

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

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	06/10/2019

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