Individual
ARCHIE THOMAS KIRKLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
125 CHURCH ST, VIDALIA, GA 30474-4770
(912) 538-8484
(912) 538-8665
Mailing address
125 CHURCH ST, VIDALIA, GA 30474-4770
(912) 538-8484
(912) 538-8665
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
7567
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
007567
GEORGIA COMPOSITE MEDICAL BOARD
GA
Enumeration date
05/12/2015
Last updated
04/09/2021
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