Provider Demographics
NPI:1548360753
Name:NORMAN, JOHNITA KENNEDY-KEYES (MD)
Entity type:Individual
Prefix:
First Name:JOHNITA
Middle Name:KENNEDY-KEYES
Last Name:NORMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3876 NEW COVINGTON PIKE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38128-2512
Mailing Address - Country:US
Mailing Address - Phone:901-377-2711
Mailing Address - Fax:901-387-2036
Practice Address - Street 1:3876 NEW COVINGTON PIKE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38128-2512
Practice Address - Country:US
Practice Address - Phone:901-377-2711
Practice Address - Fax:901-387-2036
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000024994208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNF86165Medicare UPIN