Provider Demographics
NPI:1649592585
Name:JEFFRESS, KRISTIAN DANIELLE (DPM)
Entity Type:Individual
Prefix:DR
First Name:KRISTIAN
Middle Name:DANIELLE
Last Name:JEFFRESS
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:DR
Other - First Name:KRISTIAN
Other - Middle Name:DANIELLE
Other - Last Name:JEFFRESS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM
Mailing Address - Street 1:110 HILL POND LN
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30458-0872
Mailing Address - Country:US
Mailing Address - Phone:912-489-3668
Mailing Address - Fax:912-489-4795
Practice Address - Street 1:110 HILL POND LN
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-0872
Practice Address - Country:US
Practice Address - Phone:912-489-3668
Practice Address - Fax:912-489-4795
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-19
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD001140213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery