Individual
JONATHAN PAUL KIFF
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
999 S MACON ST, JESUP, GA 31545-0240
(912) 385-2732
Mailing address
999 S MACON ST, JESUP, GA 31545-0240
(912) 385-2732
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
004801
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
117114997D
—
GA
01
—
202I972956
MEDICARE PTAN NUMBER
—
Enumeration date
07/02/2006
Last updated
11/14/2018
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