| Gene S. Kennedy M.d. P.c. | |
|
101 Heron Walk St Simons Island GA 31522-2585 | |
| (912) 634-2651 | |
| (912) 634-2653 |
| Full Name | Gene S. Kennedy M.d. P.c. |
|---|---|
| Speciality | Family Medicine |
| Location | 101 Heron Walk, St Simons Island, Georgia |
| Authorized Official Name and Position | Marion Elaine Kennedy (TREASURER/SECRETARY) |
| Authorized Official Contact | 9126342651 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gene S. Kennedy M.d. P.c. Po Box 20647 St Simons Island GA 31522-0247 Ph: (912) 634-2651 | Gene S. Kennedy M.d. P.c. 101 Heron Walk St Simons Island GA 31522-2585 Ph: (912) 634-2651 |
| NPI Number | 1528401056 |
|---|---|
| Provider Enumeration Date | 04/15/2013 |
| Last Update Date | 08/05/2013 |
| Medicare PECOS PAC ID | 6800883620 |
|---|---|
| Medicare Enrollment ID | O20130823000680 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528401056 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 050645 (Georgia) | Primary |
| Provider Name | Gene S Kennedy |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1255438214 PECOS PAC ID: 6608820170 Enrollment ID: I20050308000559 |
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