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Individual

STACI N KENNER

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
95B-A, J.F. HARRIS PKWY, SUITE 102, CARTERSVILLE, GA 30120-2158
(770) 386-4824
(770) 386-4220
Mailing address
95B-A, J.F. HARRIS PKWY, SUITE 102, CARTERSVILLE, GA 30120-2158
(770) 386-4824
(770) 386-4220

Taxonomy

Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
BPI0030889
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
00312B113A
GA
Enumeration date
07/01/2008
Last updated
12/13/2013
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