Provider Demographics
NPI:1952690224
Name:CADDELL, KIRK ALLAN (MD)
Entity Type:Individual
Prefix:
First Name:KIRK
Middle Name:ALLAN
Last Name:CADDELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1127 EARL FRYE BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:AMORY
Mailing Address - State:MS
Mailing Address - Zip Code:38821-5516
Mailing Address - Country:US
Mailing Address - Phone:662-256-3333
Mailing Address - Fax:662-256-5166
Practice Address - Street 1:1127 EARL FRYE BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:AMORY
Practice Address - State:MS
Practice Address - Zip Code:38821-5516
Practice Address - Country:US
Practice Address - Phone:662-256-3333
Practice Address - Fax:662-256-5166
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-07
Last Update Date:2016-10-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MS24445208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery