Provider Demographics
NPI:1841434255
Name:KISSELBURG, JAMES R (M,D)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:R
Last Name:KISSELBURG
Suffix:
Gender:M
Credentials:M,D
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Mailing Address - Street 1:1900 TEBEAU STREET
Mailing Address - Street 2:MAYO CLINIC HEALTH SYSTEM
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31501
Mailing Address - Country:US
Mailing Address - Phone:912-338-6438
Mailing Address - Fax:912-338-6439
Practice Address - Street 1:1900 TEBEAU STREET
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31501
Practice Address - Country:US
Practice Address - Phone:912-338-6438
Practice Address - Fax:912-338-6439
Is Sole Proprietor?:No
Enumeration Date:2009-04-29
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA76594208M00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist