| Dr Kenneith Durden Outreach | |
|
41 Moonlight Trl Port Wentworth GA 31407-3321 | |
| (404) 909-2442 | |
| Not Available |
| Full Name | Dr Kenneith Durden Outreach |
|---|---|
| Speciality | Counselor - Professional |
| Location | 41 Moonlight Trl, Port Wentworth, Georgia |
| Authorized Official Name and Position | Kenneith Durden (CEO) |
| Authorized Official Contact | 4049092442 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Dr Kenneith Durden Outreach 41 Moonlight Trl Port Wentworth GA 31407-3321 Ph: (404) 909-2442 | Dr Kenneith Durden Outreach 41 Moonlight Trl Port Wentworth GA 31407-3321 Ph: (404) 909-2442 |
| NPI Number | 1699120410 |
|---|---|
| Provider Enumeration Date | 04/29/2016 |
| Last Update Date | 04/29/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699120410 | NPI | - | NPPES |
| 803411511B | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
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