MEDICARE: WILLIAM KITTLE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	025197	GA

General Provider Information

NPI Number	:	1962455758
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM KITTLE M.D.

Provider Business Mailing Address
First Line	:	820 SAINT SEBASTIAN WAY
Second Line	:	SUITE 5C
City	:	AUGUSTA
State	:	GA
Zip	:	30901-2643
Country	:	US
Telephone Number	:	706-774-5995
Fax Number	:

Provider Business Practice Location Address
First Line	:	820 SAINT SEBASTIAN WAY
Second Line	:	SUITE 5C
City	:	AUGUSTA
State	:	GA
Zip	:	30901-2643
Country	:	US
Telephone Number	:	706-774-5995
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/19/2006
Last Update Date	:	07/08/2007

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Directions to “ WILLIAM KITTLE M.D.” Practice Location

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