Provider Demographics
NPI:1538127519
Name:UPDEGRAFF, KRISTEN ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:ANN
Last Name:UPDEGRAFF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9 CHATHAM CTR S
Mailing Address - Street 2:SUITE C
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-7456
Mailing Address - Country:US
Mailing Address - Phone:912-527-7211
Mailing Address - Fax:912-527-7222
Practice Address - Street 1:9 CHATHAM CTR S
Practice Address - Street 2:SUITE C
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-7456
Practice Address - Country:US
Practice Address - Phone:912-527-7211
Practice Address - Fax:912-527-7222
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2007-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA052871207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP00349531OtherRR MEDICARE
GAP00349531OtherRR MEDICARE
H88072Medicare UPIN