Provider Demographics
NPI:1568559185
Name:KITCHENS, JEFFERY A (PA)
Entity Type:Individual
Prefix:
First Name:JEFFERY
Middle Name:A
Last Name:KITCHENS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1466 OSSAHATCHIE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:ELLERSLIE
Mailing Address - State:GA
Mailing Address - Zip Code:31807-5338
Mailing Address - Country:US
Mailing Address - Phone:706-545-4978
Mailing Address - Fax:
Practice Address - Street 1:1466 OSSAHATCHIE CREEK RD
Practice Address - Street 2:
Practice Address - City:ELLERSLIE
Practice Address - State:GA
Practice Address - Zip Code:31807-5338
Practice Address - Country:US
Practice Address - Phone:706-545-4978
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant