CALLIE KENNEDY (NPI# 1023412640) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1023412640 |
| Entity Type | Individual |
| Full Name | CALLIE KENNEDY |
| Practice Address |
1255 Highway 54 W Fayetteville GA 30214-4526 |
| Mailing Address |
1968 Peachtree Rd Nw Atlanta GA 30309-1281 |
| Practice Telephone | 7707197000 |
| Mailing Telephone | 4046055000 |
| Enumeration Date | 2014-10-09 |
| Last Update Date | 2014-10-09 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 367H00000X | Anesthesiologist Assistant | 6385 | GA | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
1255 HIGHWAY 54 W |
| City | FAYETTEVILLE |
| State | GA |
| Zip Code | 30214-4526 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790759579 | Terrence Wise | Internal Medicine | 1255 Highway 54 W, Fayetteville, GA 30214-4526 | 2006-02-16 |
| 1518575737 | Lillie La Marre | Anesthesiologist Assistant | 1255 Highway 54 W, Fayetteville, GA 30214-4526 | 2020-07-14 |
| 1932723285 | Janam Nilesh Patel | Anesthesiologist Assistant | 1255 Highway 54 W, Fayetteville, GA 30214-4526 | 2020-06-02 |
| 1851934541 | Kara Elizabeth Wright | Registered Nurse | 1255 Highway 54 W, Fayetteville, GA 30214-4526 | 2019-10-24 |
| 1093370827 | Virginia Ann Horan | Physician Assistant | 1255 Highway 54 W, Fayetteville, GA 30214-4526 | 2019-05-07 |
| 1588123285 | Morgan Roberson | Nurse Practitioner | 1255 Highway 54 W, Fayetteville, GA 30214-4526 | 2019-03-13 |
| 1174099410 | Ellen Marie Morris-white | Nurse Practitioner | 1255 Highway 54 W, Fayetteville, GA 30214-4526 | 2018-10-14 |
| 1851874085 | Monika Hill | Nurse Practitioner | 1255 Highway 54 W, Fayetteville, GA 30214-4526 | 2018-09-13 |
| 1700368958 | Kristen Dawn Graddy | Occupational Therapist | 1255 Highway 54 W, Fayetteville, GA 30214-4526 | 2018-09-04 |
| 1407342603 | Mary Grace B Nuega | Nurse Practitioner | 1255 Highway 54 W, Fayetteville, GA 30214-4526 | 2018-07-11 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548872468 | Phyllis Kelly Wood | Nurse Practitioner | 217 Banks Rd, Suite 31, Fayetteville, GA 30214 | 2020-08-21 |
| 1073139317 | Tyisha Salter Scott | Counselor | 110 Habersham Drive, Suite 142, Fayetteville, GA 30214 | 2020-06-23 |
| 1194341412 | Camille Franncine Bolton | Physical Therapist | 500 Floy Farr Parkway, Suite 303, Fayetteville, GA 30214 | 2020-06-23 |
| 1205465895 | Gillian Vaughan Heard | Physician Assistant | 1275 Ga-54 #201, Fayetteville, GA 30214 | 2020-04-06 |
| 1881234557 | Peach Fits,inc | Mastectomy Fitter | 285 Glynn Street South, Suites 102 and 104, Fayetteville, GA 30214 | 2020-01-10 |
| 1255981072 | Delta Healthcare Providers | Clinic/Center | 1275 W Lanier Ave, #200, Fayetteville, GA 30214 | 2019-09-13 |
| 1861965592 | Hierarchy for Wellness | Specialist | 805 S Glynn St Bldg 127 142, Fayetteville, GA 30214 | 2019-01-04 |
| 1356810634 | Fayette Dental Group PC | Clinic/Center | 720 W Lanier Ave, Fayetteville, GA 30214 | 2018-11-16 |
| 1891263299 | Mattie Mae Farmer Clark | Specialist/Technologist, Other | Piedmont Fayette Hospital, 1255 Highway 54 West, Fayetteville, GA 30214 | 2018-11-05 |
| 1093293607 | Allyson Holland | Pharmacist | 880 Highway 85 South, Fayetteville, GA 30214 | 2018-08-06 |
| Find all providers in zip 30214 | ||||
| Taxonomy Code | 367H00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Anesthesiologist Assistant |
| An individual certified by the state to perform anesthesia services under the direct supervision of an anesthesiologist. Anesthesiologist Assistants are required to have a bachelor's degree with a premed curriculum prior to entering a two-year anesthesiology assistant program, which is focused upon the delivery and maintenance of anesthesia care as well as advanced patient monitoring techniques. An Anesthesiologist Assistant must work as a member of the anesthesia care team under the direction of a qualified Anesthesiologist. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053630392 | Michael D Keats | Anesthesiologist Assistant | 1255 Highway 54 West, Fayetteville, GA 30214-4548 | 2010-05-26 |
| 1518575737 | Lillie La Marre | Anesthesiologist Assistant | 1255 Highway 54 W, Fayetteville, GA 30214-4526 | 2020-07-14 |
| 1932723285 | Janam Nilesh Patel | Anesthesiologist Assistant | 1255 Highway 54 W, Fayetteville, GA 30214-4526 | 2020-06-02 |
| 1104484567 | Jessica Ashe Lewis | Anesthesiologist Assistant | 1255 Ga-54, Fayetteville, GA 30214 | 2019-05-31 |
| 1073079182 | Christopher Robert Brown | Anesthesiologist Assistant | 1255 Ga-54, Fayetteville, GA 30214 | 2019-02-13 |
| 1205322302 | Joshua Gordon | Anesthesiologist Assistant | 1255 Ga-54, Fayetteville, GA 30214 | 2018-07-02 |
| 1326532771 | Cheyenne Marie Lukstein | Anesthesiologist Assistant | 1255 Highway 54 W, Fayetteville, GA 30214-4526 | 2018-06-19 |
| 1407344237 | Stewart T Weisheit | Anesthesiologist Assistant | 1255 Highway 54 W, Fayetteville, GA 30214-4526 | 2018-04-26 |
| 1598133548 | Virginia Trogdon | Anesthesiologist Assistant | 1255 Highway 54 W, Fayetteville, GA 30214-4526 | 2015-09-08 |
| 1003284498 | Danielle Duncan | Anesthesiologist Assistant | 1255 Highway 54 W, Fayetteville, GA 30214-4526 | 2015-09-02 |
| Find all providers in FAYETTEVILLE | ||||
| City | FAYETTEVILLE |
| Zip Code | 30214 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.