Provider Demographics
NPI:1316931975
Name:HANDY, KENDALL M (MD)
Entity type:Individual
Prefix:
First Name:KENDALL
Middle Name:M
Last Name:HANDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1038
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31902-1038
Mailing Address - Country:US
Mailing Address - Phone:706-571-1192
Mailing Address - Fax:706-571-1115
Practice Address - Street 1:2000 10TH AVE
Practice Address - Street 2:SUITE 180
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-3700
Practice Address - Country:US
Practice Address - Phone:706-571-1519
Practice Address - Fax:706-320-8675
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA031933207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAE70219Medicare UPIN