Sheila Kennedy, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

68227 Issued in GA

Practice address

1430 Five Forks Trickum Rd St 220
Lawrenceville, GA 30044-8182

Phone

(678) 578-4983

Fax

(678) 578-4988

NPI assigned

Jul 30, 2009

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• The Southeast Permanente Medical Group

  • Internal Medicine Physician
  • Atlanta, GA
  • NPI 1245266956

  Family Medicine

  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1248912000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1428537600000",
    "number": "1013148626",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2491 PANOLA RD",
            "city": "LITHONIA",
            "state": "GA",
            "postal_code": "300584831",
            "telephone_number": "678-205-4999",
            "fax_number": "678-205-4969"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1430 FIVE FORKS TRICKUM RD ST 220",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300448182",
            "telephone_number": "678-578-4983",
            "fax_number": "678-578-4988"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENNEDY",
        "first_name": "SHEILA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-07-30",
        "last_updated": "2015-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "68227",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NJ",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003140093B",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003140093A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Amanda L Kembel, CRNA
• Shelby Kemp, DC
• Kaylee Kennedy, OTD, OTR
• Madeleine O. Kennedy, NP
• Salem Ray Kennedy
• Emily Gayle Kennerson, MS, BCBA
• Kenneth E Starling, Jr DDS PC
• Kenneth J. Sobel, MD
• Jared Thomas Kent, DMD
• Rebecca Kern

• Family Medicine Physician in Lawrenceville, GA
• Providers in Lawrenceville, GA by specialty
• Family Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.