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NPI Code Detail

MEDICARE: KENNETH DEWAYNE PERRY

MEDICARE: KENNETH DEWAYNE PERRY
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
11041C0700XClinical Social Worker8145TN

General Provider Information

NPI Number : 1922770528
Entity Type Code : Individual
Provider Name (Legal Business Name) : KENNETH DEWAYNE PERRY
Provider Business Mailing Address
First Line : PO BOX 746725
Second Line :
City : ATLANTA
State : GA
Zip : 30374-6725
Country : US
Telephone Number : 312-733-9730
Fax Number :
Provider Business Practice Location Address
First Line : 112 N LIBERTY ST
Second Line :
City : JACKSON
State : TN
Zip : 38301-6200
Country : US
Telephone Number : 731-736-4400
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/01/2021
Last Update Date : 09/09/2025

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Directions to “ KENNETH DEWAYNE PERRY ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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