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NPI Code Detail

MEDICARE: ARCHIE THOMAS KIRKLEY PA-C

MEDICARE: ARCHIE THOMAS KIRKLEY PA-C
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
1363A00000XPhysician Assistant7567GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1007567OTHERGAGEORGIA COMPOSITE MEDICAL BOARD

General Provider Information

NPI Number : 1427436393
Entity Type Code : Individual
Provider Name (Legal Business Name) : ARCHIE THOMAS KIRKLEY PA-C
Provider Business Mailing Address
First Line : 125 CHURCH ST
Second Line :
City : VIDALIA
State : GA
Zip : 30474-4770
Country : US
Telephone Number : 912-538-8484
Fax Number : 912-538-8665
Provider Business Practice Location Address
First Line : 125 CHURCH ST
Second Line :
City : VIDALIA
State : GA
Zip : 30474-4770
Country : US
Telephone Number : 912-538-8484
Fax Number : 912-538-8665
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/12/2015
Last Update Date : 04/09/2021

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Directions to “ ARCHIE THOMAS KIRKLEY PA-C” Practice Location

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