Provider Demographics
NPI:1720019508
Name:KINGSLEY, JEFFREY KENNETH (DO)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:KENNETH
Last Name:KINGSLEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 TALBOTTON RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904
Mailing Address - Country:US
Mailing Address - Phone:706-596-4894
Mailing Address - Fax:706-320-0629
Practice Address - Street 1:800 TALBOTTON RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904
Practice Address - Country:US
Practice Address - Phone:706-596-4894
Practice Address - Fax:706-320-0629
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA052973207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA252539178AMedicaid
GAI09973Medicare UPIN
GA08BBRBLMedicare ID - Type Unspecified