Provider Demographics
NPI:1164598710
Name:HAMPTON, KIRSTEN J (MD)
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:J
Last Name:HAMPTON
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:PO BOX 3118
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31205
Mailing Address - Country:US
Mailing Address - Phone:478-788-4007
Mailing Address - Fax:478-788-5070
Practice Address - Street 1:4310 HARTLEY BRIDGE RD
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31216
Practice Address - Country:US
Practice Address - Phone:478-788-4007
Practice Address - Fax:478-788-5070
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA051141207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP6759OtherMEDICARE GRP
GAGRP6759OtherMEDICARE GRP
GA08BBRJPMedicare ID - Type Unspecified