Individual
DR. KENNETH JAY HEADEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
806 SUMMIT AVE, GREENSBORO, NC 27405-7861
(336) 437-2354
(336) 279-1226
Mailing address
806 SUMMIT AVE, GREENSBORO, NC 27405-7861
(336) 437-2354
(336) 279-1226
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
9400266
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5917028
—
NC
Enumeration date
05/04/2007
Last updated
06/29/2015
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