Provider Demographics
NPI:1780616904
Name:KITCHEN, STEPHEN F (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:F
Last Name:KITCHEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3226 HAMPTON AVE STE B
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-4257
Mailing Address - Country:US
Mailing Address - Phone:912-265-0492
Mailing Address - Fax:912-265-1091
Practice Address - Street 1:3226 HAMPTON AVE STE B
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-4257
Practice Address - Country:US
Practice Address - Phone:912-265-0492
Practice Address - Fax:912-265-1091
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA039839208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00665035BMedicaid
GA02B0FFZMedicare ID - Type Unspecified
F69248Medicare UPIN