Individual
DR. JESSE KENWOOD GIFFHORN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1199 PRINCE AVE, ATHENS, GA 30606-2797
(706) 475-3665
Mailing address
4881 SUGAR MAPLE DR, DAYTON, OH 45433-5529
(937) 257-6991
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
35.140501
OH
208000000X
Pediatrics Physician
Primary
94737
GA
208M00000X
Hospitalist Physician
35.140501
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0419629
—
OH
Enumeration date
05/03/2012
Last updated
06/15/2023
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