Provider Demographics
NPI:1225599707
Name:LE, KENDRA JOHANNA (DO)
Entity type:Individual
Prefix:DR
First Name:KENDRA
Middle Name:JOHANNA
Last Name:LE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12 EXECUTIVE PARK DR NE FL 5
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30329-2206
Mailing Address - Country:US
Mailing Address - Phone:404-778-5526
Mailing Address - Fax:404-712-7436
Practice Address - Street 1:12 EXECUTIVE PARK DR NE FL 5
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-2206
Practice Address - Country:US
Practice Address - Phone:404-778-5526
Practice Address - Fax:404-712-7436
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-27
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXT31232084P0800X
TXBP10068083390200000X
GA955102084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program