Provider Demographics
NPI:1053938720
Name:KENNEDY, VEDA N
Entity type:Individual
Prefix:
First Name:VEDA
Middle Name:N
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:VEDA
Other - Middle Name:
Other - Last Name:LANGFORD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3660 FLAT SHOALS RD STE 180
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30034-1637
Mailing Address - Country:US
Mailing Address - Phone:404-243-7777
Mailing Address - Fax:404-284-7676
Practice Address - Street 1:3660 FLAT SHOALS RD STE 180
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30034-1637
Practice Address - Country:US
Practice Address - Phone:404-283-7777
Practice Address - Fax:404-284-7676
Is Sole Proprietor?:No
Enumeration Date:2020-06-29
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN259922163WW0101X, 363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory