Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | 40438 | GA |
NPI | 1265518328 |
---|---|
Provider Name | Dr. Keith Alan Kirby |
First Address | Savannah, GA 31405-5710 |
Second Address | Savannah, GA 31405-5719 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2006 |
Last Update Date | 03/01/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
201577941 | INTERNAL REVENUE SERVICE (01) | |
F25305 | (02) | GA |