Individual
MS. PAIGE B. KENWAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AGPCNP-BC
Contact information
Practice address
132 OLD NORTON RD STE 200, FAYETTEVILLE, GA 30215-4873
(678) 817-1117
(678) 817-0823
Mailing address
1835 SAVOY DR STE 300, ATLANTA, GA 30341-1071
(678) 817-1117
(678) 817-0823
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
RN222344
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003217336A
—
GA
01
—
G11383A
MEDICARE PTAN
GA
Enumeration date
03/25/2019
Last updated
08/24/2020
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