John Sargent Kennedy, M.D.

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

25193 Issued in GA

Practice address

2665 N Decatur Rd
Suite 730
Decatur, GA 30033-6149

Phone

(404) 508-4320

Fax

(404) 508-4112

NPI assigned

Aug 24, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

Specialty

General Surgery

Education

Temple University School of Medicine, 1982

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Northside Surgical Professional Services LLCGroup PAC ID 8628253424, 367 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Emory Decatur Hospital Hospital, Decatur, GA, CCN 110076
• Northside Hospital Hospital, Atlanta, GA, CCN 110161
• Emory Hillandale Hospital Hospital, Lithonia, GA, CCN 110226

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• Dekalb Surgical Associates, P.C.

  • Specialist
  • Decatur, GA
  • NPI 1770532590
  Medicare reassignment NPD Authorized official
• Northside Surgical Professional Services LLC

  • Surgery Physician
  • Atlanta, GA
  • NPI 1356630990
  Medicare reassignment Care Compare group NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Dekalb Medical Center, Inc.

  • General Acute Care Hospital
  • Decatur, GA
  • NPI 1093716979
  Care Compare affiliation
• Dekalb Medical Center, Inc.

  • General Acute Care Hospital
  • Lithonia, GA
  • NPI 1962403865
  Care Compare affiliation
• Northside Hospital, Inc.

  • General Acute Care Hospital
  • Atlanta, GA
  • NPI 1457396079
  Care Compare affiliation

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

{
    "created_epoch": "1124841600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736899200000",
    "number": "1275526386",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2665 N DECATUR RD",
            "address_2": "SUITE 730",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300336149",
            "telephone_number": "404-508-4320",
            "fax_number": "404-508-4112"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2665 N DECATUR RD",
            "address_2": "SUITE 730",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300336149",
            "telephone_number": "404-508-4320",
            "fax_number": "404-508-4112"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1462 Montreal Rd Ste 303",
            "address_purpose": "LOCATION",
            "city": "Tucker",
            "state": "GA",
            "postal_code": "300846924",
            "country_code": "US",
            "telephone_number": "404-508-4320",
            "fax_number": "404-508-4112",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KENNEDY",
        "first_name": "JOHN",
        "middle_name": "SARGENT",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-24",
        "last_updated": "2025-01-15",
        "certification_date": "2025-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "GA",
            "license": "25193",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00280167C",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Carolyn Delois Kendrick, R.D.
• Judith Rebecca Kenen, MAC LAC
• Christy Kennedy, OTR/L
• James P Kennedy, D.D.S.
• Jan C Kennedy, MD
• Krista Kennedy
• Leiona Kennedy
• Margaret Ann Kennedy, FNP-C
• Ryan Wright Kennedy, DMD
• Veda N Kennedy

• Surgery Physician in Decatur, GA
• Providers in Decatur, GA by specialty
• Surgery Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2025; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.