Provider Demographics
NPI:1609815729
Name:KITCHENS, WILLIAM CLIFFORD (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:CLIFFORD
Last Name:KITCHENS
Suffix:
Gender:M
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 1705
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30903-1705
Mailing Address - Country:US
Mailing Address - Phone:706-774-7263
Mailing Address - Fax:706-774-7230
Practice Address - Street 1:1348 WALTON WAY STE 5700
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901-5110
Practice Address - Country:US
Practice Address - Phone:706-722-8242
Practice Address - Fax:706-722-8351
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA056731208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51503505OtherBLUE CROSS
AL051503505Medicaid
AL051503505Medicaid