Individual
DR. KENNETH ROBERT TENNANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
223 S MAIN ST, MADISON, GA 30650-1351
(706) 343-1876
(706) 343-1877
Mailing address
223 S MAIN ST, MADISON, GA 30650-1351
(706) 343-1876
(706) 343-1877
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2045
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
374592414B
—
GA
Enumeration date
01/11/2006
Last updated
12/11/2009
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