MEDICARE: CHERYL J KENDALL 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	2080A0000X	Pediatric Adolescent Medicine Physician	025773	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
2	819825	OTHER	GA	BLUECROSS/BLUESHIELD

General Provider Information

NPI Number	:	1801848999
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHERYL J KENDALL M.D.

Provider Business Mailing Address
First Line	:	777 CLEVELAND AVE SW
Second Line	:	#400
City	:	ATLANTA
State	:	GA
Zip	:	30315-7129
Country	:	US
Telephone Number	:	404-766-3337
Fax Number	:	404-766-1464

Provider Business Practice Location Address
First Line	:	777 CLEVELAND AVE SW
Second Line	:	#400
City	:	ATLANTA
State	:	GA
Zip	:	30315-7129
Country	:	US
Telephone Number	:	404-766-3337
Fax Number	:	404-766-1464

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

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	07/25/2008

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