Provider Demographics
NPI:1679389399
Name:KENNEDY, SARAH A
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:A
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 BIRCH TREE CT
Mailing Address - Street 2:
Mailing Address - City:ODENVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35120-6889
Mailing Address - Country:US
Mailing Address - Phone:205-907-7187
Mailing Address - Fax:
Practice Address - Street 1:2375 W BROAD ST STE G
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-3453
Practice Address - Country:US
Practice Address - Phone:706-567-6151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-06
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical