Provider Demographics
NPI:1962428318
Name:KENNEDY, ARTHUR KOBINA (MD)
Entity type:Individual
Prefix:DR
First Name:ARTHUR
Middle Name:KOBINA
Last Name:KENNEDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5900 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-6227
Mailing Address - Country:US
Mailing Address - Phone:803-888-5425
Mailing Address - Fax:803-830-5446
Practice Address - Street 1:5900 N MAIN ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-6227
Practice Address - Country:US
Practice Address - Phone:803-888-5425
Practice Address - Fax:803-830-5446
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20025207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCG09201Medicare UPIN
SCAA47999326Medicare PIN