1881658300 NPI number — DR. FRANCES DOUGHERTY KENDALL MD

Table of content: DR. FRANCES DOUGHERTY KENDALL MD (NPI 1881658300)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881658300 NPI number — DR. FRANCES DOUGHERTY KENDALL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KENDALL
Provider First Name:
FRANCES
Provider Middle Name:
DOUGHERTY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DOUGHERTY
Provider Other First Name:
FRANCES
Provider Other Middle Name:
ELIZABETH
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1881658300
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/16/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5579 CHAMBLEE DUNWOODY RD
Provider Second Line Business Mailing Address:
STE 110
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30338-4128
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-793-7800
Provider Business Mailing Address Fax Number:
866-744-5665

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1875 OLD ALABAMA RD
Provider Second Line Business Practice Location Address:
STE 220
Provider Business Practice Location Address City Name:
ROSWELL
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30076-2272
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-793-7800
Provider Business Practice Location Address Fax Number:
866-744-5665
Provider Enumeration Date:
04/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207SG0201X , with the licence number:  044706 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207SG0202X , with the licence number: 044706 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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