Individual
JASON DEWAYNE KENNEDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2525 DESALES AVE, CHATTANOOGA, TN 37404-1161
(423) 495-7404
Mailing address
2525 DESALES AVE, CHATTANOOGA, TN 37404-1161
(615) 484-5316
(423) 495-2625
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
26161
AL
207LC0200X
Critical Care Medicine (Anesthesiology) Physician
46094
TN
207LC0200X
Critical Care Medicine (Anesthesiology) Physician
Primary
61105
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009942534
—
AL
05
—
009942536
—
AL
05
—
009942537
—
AL
05
—
009942538
—
AL
01
—
051540437
BLUE CROSS
AL
01
—
051540445
BLUE CROSS
AL
01
—
051540446
BLUE CROSS
AL
01
—
051540447
BLUE CROSS
AL
Enumeration date
02/09/2007
Last updated
08/21/2024
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