Healthcare Provider Details

I. General information

NPI: 1245304013
Provider Name (Legal Business Name): FRANK DAVID KUITEMS MD, ABIM BOARD CERT.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 07/15/2024
Certification Date: 02/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 BLUE RIDGE OVERLOOK
BLUE RIDGE GA
30513-4431
US

IV. Provider business mailing address

165 BLUE RIDGE OVERLOOK
BLUE RIDGE GA
30513-4431
US

V. Phone/Fax

Practice location:
  • Phone: 706-946-4647
  • Fax: 706-374-7628
Mailing address:
  • Phone: 706-946-5607
  • Fax: 706-374-7628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number027213
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: