Individual
J LEX KENERLY III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
110 PROFESSIONAL CT, JESUP, GA 31545-0044
(912) 427-0800
(912) 427-6029
Mailing address
PO BOX 1334, JESUP, GA 31598-1334
(912) 427-0800
(912) 427-6029
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
030633
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000374921A
—
GA
05
—
000374921H
—
GA
05
—
00374921F
—
GA
01
—
10062286
AMERIGROUP
GA
01
—
200004881
MEDICARE RAILROAD
GA
01
—
341213
WELLCARE
GA
Enumeration date
06/28/2005
Last updated
06/30/2015
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