Individual
DR. WENTZELLE KIM KITCHENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
501 SPARTA RD, SUITE F, SANDERSVILLE, GA 31082-1371
(478) 552-0001
(478) 552-0048
Mailing address
501 SPARTA RD, SUITE F, SANDERSVILLE, GA 31082-1371
(478) 552-0001
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
038277
GA
207RS0012X
Sleep Medicine (Internal Medicine) Physician
038277
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00597605A
—
GA
05
—
00597605B
—
GA
01
—
110083260
RAILROAD MEDICARE
GA
01
—
476142
BCBS
GA
Enumeration date
04/19/2006
Last updated
08/14/2013
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