Individual
MR. CHARLES REGGIE KENNEDY SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CERTIFIED ORTHOTIST
Contact information
Practice address
777 LAKELAND DR, JACKSON, MS 39216-4611
(601) 815-4844
Mailing address
503 CEDAR ST, MIZE, MS 39116-5572
(601) 733-2327
Taxonomy
Speciality
Code
Description
License number
State
222Z00000X
Orthotist
Primary
C0004097
MS
Other
Enumeration date
03/10/2010
Last updated
03/10/2010
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