Individual
NICHOLAS LEE KENNEDY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1025 VERDAE BLVD STE A, GREENVILLE, SC 29607-4032
(864) 242-4683
(864) 242-8104
Mailing address
300 E MCBEE AVE FL 4, GREENVILLE, SC 29601-2842
(864) 522-8614
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
40717
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
407170
—
SC
01
—
SCI477
MEDICARE
SC
Enumeration date
04/28/2017
Last updated
06/01/2021
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