MEDICARE: MR. FRED JASON KIGHT 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	207N00000X	Dermatology Physician	026572	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	52047422-001	OTHER	GA	BLUE CROSS BLUE SHIELD PR

General Provider Information

NPI Number	:	1437142072
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. FRED JASON KIGHT M.D.

Provider Business Mailing Address
First Line	:	1248 AUGUSTA WEST PKWY
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30909-1854
Country	:	US
Telephone Number	:	706-863-0500
Fax Number	:

Provider Business Practice Location Address
First Line	:	1248 AUGUSTA WEST PKWY
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30909-1854
Country	:	US
Telephone Number	:	706-863-0500
Fax Number	:

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

Provider Enumeration Date	:	08/30/2005
Last Update Date	:	07/08/2007

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