Philip R Kennedy, MD

Primary specialty

Neurology PhysicianTaxonomy code 2084N0400X

License

GA03970B Issued in GA

Practice address

3400 McClure Bridge Rd
Suite D401
Duluth, GA 30096-6675

Phone

(770) 622-2230

Fax

(770) 622-9741

NPI assigned

Jun 21, 2005

Last updated

Jan 23, 2009By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/8042/brand/1/csg/1/fhir/r4

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

• Privia Medical Group of Georgia LLC

  • Internal Medicine Physician
  • Fayetteville, GA
  • NPI 1013313857
  Medicare reassignment NPD
• Community Neurological Clinic

  • Specialist
  • Duluth, GA
  • NPI 1164614608
  Authorized official Same address or phone
• Neural Signals Inc

  • Customized Equipment (DME)
  • Duluth, GA
  • NPI 1689691495
  Authorized official Same address or phone
• Privia Medical Group of Georgia LLC

  • Internal Medicine Physician
  • Savannah, GA
  • NPI 1356907273
  NPD

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

{
    "created_epoch": "1119312000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1232668800000",
    "number": "1912903485",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3400 MCCLURE BRIDGE RD",
            "address_2": "SUITE D401",
            "city": "DULUTH",
            "state": "GA",
            "postal_code": "300966675",
            "telephone_number": "770-622-2230",
            "fax_number": "770-622-9741"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3400 MCCLURE BRIDGE RD",
            "address_2": "SUITE D401",
            "city": "DULUTH",
            "state": "GA",
            "postal_code": "300966675",
            "telephone_number": "770-622-2230",
            "fax_number": "770-622-9741"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENNEDY",
        "first_name": "PHILIP",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-06-21",
        "last_updated": "2009-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "GA",
            "license": "GA03970B",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000772813A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alexa Kelly
• Megan Renee Kelly, M.S., CCC-SLP
• Natalie Kelly
• Kelsey Faith Kempner
• Barry Kennedy, D.D.S.
• Grace Alexandra Kenney, PT, DPT
• Sarah E Kersey
• Keys to a Better Chance Counseling and Consulting, LLC
• Usama Khalid, M.D.
• Afrah Khan

• Neurology Physician in Duluth, GA
• Providers in Duluth, GA by specialty
• Neurology Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2009; 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.