Provider Demographics
NPI:1558112896
Name:GOERGEN, KAYLEE (DO)
Entity Type:Individual
Prefix:
First Name:KAYLEE
Middle Name:
Last Name:GOERGEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5240 BARBERRY AVE
Mailing Address - Street 2:
Mailing Address - City:OAKWOOD
Mailing Address - State:GA
Mailing Address - Zip Code:30566-0343
Mailing Address - Country:US
Mailing Address - Phone:623-337-2530
Mailing Address - Fax:
Practice Address - Street 1:1439 JESSE JEWELL PKWY NE STE 102
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3806
Practice Address - Country:US
Practice Address - Phone:770-219-9445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-27
Last Update Date:2024-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program