Provider Demographics
NPI:1114926201
Name:KITCHEN, FELISHA LOVE (MD)
Entity Type:Individual
Prefix:
First Name:FELISHA
Middle Name:LOVE
Last Name:KITCHEN
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 1:770 PINE ST STE 580
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-7532
Mailing Address - Country:US
Mailing Address - Phone:478-633-1821
Mailing Address - Fax:478-633-5180
Practice Address - Street 1:770 PINE ST STE 580
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-7532
Practice Address - Country:US
Practice Address - Phone:478-633-1821
Practice Address - Fax:478-633-5180
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-20
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA051343207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA739099977DMedicaid
GAH64661Medicare UPIN
GAH64661Medicare UPIN