Organization Active NPI

Kenny R. Sinervo, MD, LLC

  • Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
  • Atlanta, GA
National Provider Identifier
1841966462
Registry record updated Aug 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) PhysicianTaxonomy code 207VF0040X
Legal business name
KENNY R. SINERVO, MD, LLC
Practice address
6105 Peachtree Dunwoody Rd Ste B230
Atlanta, GA 30328-5928
Phone
(770) 913-0001
Fax
(770) 913-0005
NPI assigned
Aug 23, 2021
Last updated
Aug 23, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
KENNY R. SINERVO, MD, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 23, 2021

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

Authorized official

Name
Anna Dorris
Title
Practice Manager
Phone
(770) 913-0001

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician 207VF0040X Primary

Addresses

Primary practice location

6105 Peachtree Dunwoody Rd Ste B230
Atlanta, GA 30328-5928

Mailing address

6105 Peachtree Dunwoody Rd Ste B230
Atlanta, GA 30328-5928
Phone (770) 913-0001

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
11D0663784Kenny R Sinervo, MD, LLC6105 Peachtree Dunwoody Road, Building B, Ste 230, Atlanta, GA 30328Provider-performed microscopyJun 20, 2027

National Provider Directory

National Provider Directory
Tax ID family
Robert B Albee Jr MD an2 organizations share this tax ID, including this one
Part of
Robert B Albee Jr MD an

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

6105 Peachtree Dunwoody Rd
Ste B230
Sandy Springs, GA 30328
Phone (770) 913-0001

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1629676800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1629676800000",
    "number": "1841966462",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6105 PEACHTREE DUNWOODY RD STE B230",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303285928",
            "telephone_number": "770-913-0001",
            "fax_number": "770-913-0005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6105 PEACHTREE DUNWOODY RD STE B230",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303285928",
            "telephone_number": "770-913-0001",
            "fax_number": "770-913-0005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENNY R. SINERVO, MD, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "KENNY R. SINERVO, MD, LLC",
        "enumeration_date": "2021-08-23",
        "last_updated": "2021-08-23",
        "certification_date": "2021-08-23",
        "status": "A",
        "authorized_official_last_name": "DORRIS",
        "authorized_official_first_name": "ANNA",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "770-913-0001"
    },
    "taxonomies": [
        {
            "code": "207VF0040X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Urogynecology and Reconstructive Pelvic Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • 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.