Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | GA447 | GA |
N | 111NR0200X | Radiology | GA447 | GA |
N | 213ER0200X | Radiology | GA447 | GA |
N | 2081S0010X | Sports Medicine | GA447 | GA |
N | 213ES0000X | Sports Medicine | GA447 | GA |
N | 213ES0103X | Foot & Ankle Surgery | GA447 | GA |
NPI | 1417008467 |
---|---|
Provider Name | Dr. Kile Woodrow Kinney |
First Address | Augusta, GA 30904-5827 |
Second Address | Augusta, GA 30904-5827 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/01/2007 |
Last Update Date | 25/06/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000167978B | (05) | GA |
616548 | BLUECROSS/BLUESHIELD (01) | |
GA447 | STATE LICENSE NUMBER (01) | GA |
T97692 | (02) | GA |