Provider Demographics
NPI:1699005231
Name:FELISHA LOVE KITCHEN, MD
Entity Type:Organization
Organization Name:FELISHA LOVE KITCHEN, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:FELISHA
Authorized Official - Middle Name:L
Authorized Official - Last Name:KITCHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:478-742-5502
Mailing Address - Street 1:1062 FORSYTH ST
Mailing Address - Street 2:SUITE 2-E
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-8637
Mailing Address - Country:US
Mailing Address - Phone:478-742-5502
Mailing Address - Fax:478-742-5505
Practice Address - Street 1:1062 FORSYTH ST
Practice Address - Street 2:SUITE 2-E
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-8637
Practice Address - Country:US
Practice Address - Phone:478-742-5502
Practice Address - Fax:478-742-5505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-04
Last Update Date:2010-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA051343207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA739099977AMedicaid
GA16BBCJPMedicare PIN
GA739099977AMedicaid