Provider Demographics
NPI:1265518328
Name:KIRBY, KEITH ALAN (MD)
Entity type:Individual
Prefix:DR
First Name:KEITH
Middle Name:ALAN
Last Name:KIRBY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8 WHEELER ST
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-5710
Mailing Address - Country:US
Mailing Address - Phone:912-352-4340
Mailing Address - Fax:912-352-4616
Practice Address - Street 1:8 WHEELER CT
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-5719
Practice Address - Country:US
Practice Address - Phone:912-352-4340
Practice Address - Fax:912-352-8931
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA40438208VP0014X, 2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
201577941OtherINTERNAL REVENUE SERVICE
GA201577941OtherTAX ID NUMBER
GA201577941OtherTAX ID NUMBER