Provider Demographics
NPI:1801210927
Name:AMY KITCHING, PC
Entity Type:Organization
Organization Name:AMY KITCHING, PC
Other - Org Name:SOUTHERN CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INSURANCE/CREDENTIALING CLERK
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:O
Authorized Official - Last Name:KITCHING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-243-9200
Mailing Address - Street 1:2 ED MOORE CT
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30458-5024
Mailing Address - Country:US
Mailing Address - Phone:912-243-9200
Mailing Address - Fax:912-243-9207
Practice Address - Street 1:2 ED MOORE CT
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-6027
Practice Address - Country:US
Practice Address - Phone:912-243-9200
Practice Address - Fax:912-243-9207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-10
Last Update Date:2014-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00883748AMedicaid
GAU35346Medicare UPIN