Organization
KENNETH J HEADEN MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KENNETH JAY HEADEN MD (MD/CEO)
(336) 279-1227
Entity
Organization
Contact information
Practice address
806 SUMMIT AVE, 210A, GREENSBORO, NC 27405-7861
(336) 279-1227
(336) 279-1226
Mailing address
806 SUMMIT AVE STE 210A, GREENSBORO, NC 27405-7861
(336) 279-1227
(336) 279-1226
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
9400266
NC
Other
Enumeration date
09/21/2012
Last updated
09/21/2012
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