Individual
DR. PHILLIP S KENNEDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3614 D J DEWEY GRAY CIRCLE, AUGUSTA, GA 30909
(706) 868-7380
(706) 868-7223
Mailing address
PO BOX 2510, EVANS, GA 30809-2510
(706) 922-8251
(706) 922-6695
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
043985
GA
207Q00000X
Family Medicine Physician
Primary
43985
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00793922A
—
GA
01
—
043985
LICENSE
GA
01
—
10056165
AMERIGROUP
GA
01
—
336986
WELLCARE
GA
01
—
43985
GA MEDICAL LICENSE
—
01
—
CH0654
RR MEDICARE GROUP PIN
GA
05
—
G43985
—
SC
Enumeration date
06/09/2006
Last updated
04/20/2026
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