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Individual

SHEILA KENNEDY

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
1430 FIVE FORKS TRICKUM RD ST 220, LAWRENCEVILLE, GA 30044-8182
(678) 578-4983
(678) 578-4988
Mailing address
2491 PANOLA RD, LITHONIA, GA 30058-4831
(678) 205-4999
(678) 205-4969

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
68227
GA
390200000X
Student in an Organized Health Care Education/Training Program
NJ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
003140093A
GA
05
003140093B
GA
Enumeration date
07/30/2009
Last updated
04/09/2015
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