Provider Demographics
NPI:1699349639
Name:KENNY, PETER IGNATIUS JR
Entity type:Individual
Prefix:MR
First Name:PETER
Middle Name:IGNATIUS
Last Name:KENNY
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1365B CLIFTON RD NE STE BT401A
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30322-1013
Mailing Address - Country:US
Mailing Address - Phone:404-778-4530
Mailing Address - Fax:404-778-4002
Practice Address - Street 1:1365B CLIFTON RD NE STE BT401A
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-3498
Practice Address - Country:US
Practice Address - Phone:404-778-4530
Practice Address - Fax:404-778-4002
Is Sole Proprietor?:No
Enumeration Date:2021-05-14
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program