Provider Demographics
NPI:1235879537
Name:KIM, JEANAH
Entity type:Individual
Prefix:
First Name:JEANAH
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 SAINT JOSEPHS CANDLER DR STE 200
Mailing Address - Street 2:
Mailing Address - City:POOLER
Mailing Address - State:GA
Mailing Address - Zip Code:31322-9585
Mailing Address - Country:US
Mailing Address - Phone:912-748-1999
Mailing Address - Fax:912-748-3847
Practice Address - Street 1:101 SAINT JOSEPHS CANDLER DR STE 200
Practice Address - Street 2:
Practice Address - City:POOLER
Practice Address - State:GA
Practice Address - Zip Code:31322-9585
Practice Address - Country:US
Practice Address - Phone:912-748-1999
Practice Address - Fax:912-748-3847
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-01
Last Update Date:2025-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA104979207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine