Provider Demographics
NPI:1962882886
Name:WANNAMAKER, KENDALL WHITFIELD JR (MD)
Entity type:Individual
Prefix:
First Name:KENDALL
Middle Name:WHITFIELD
Last Name:WANNAMAKER
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:KENDALL
Other - Middle Name:W
Other - Last Name:WANNAMAKER
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2170 MIDLAND RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHERN PINES
Mailing Address - State:NC
Mailing Address - Zip Code:28387-2927
Mailing Address - Country:US
Mailing Address - Phone:910-295-2100
Mailing Address - Fax:910-295-3625
Practice Address - Street 1:2170 MIDLAND RD
Practice Address - Street 2:
Practice Address - City:SOUTHERN PINES
Practice Address - State:NC
Practice Address - Zip Code:28387-2927
Practice Address - Country:US
Practice Address - Phone:910-295-2100
Practice Address - Fax:910-295-3625
Is Sole Proprietor?:No
Enumeration Date:2015-06-05
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYTP302207W00000X
SCLL38304207R00000X
OH35136292207W00000X
NC2021-01183207W00000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist