Provider Demographics
NPI:1114982709
Name:KIME, DEBRA S (PA)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:S
Last Name:KIME
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 THIRD STREET
Mailing Address - Street 2:STE 204
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201
Mailing Address - Country:US
Mailing Address - Phone:478-464-2600
Mailing Address - Fax:478-742-2040
Practice Address - Street 1:610 THIRD STREET
Practice Address - Street 2:STE 204
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201
Practice Address - Country:US
Practice Address - Phone:478-464-2600
Practice Address - Fax:478-742-2040
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004635363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA97WCHFPMedicare ID - Type Unspecified
GAQ60411Medicare UPIN