Individual
MAXWELL KUYKENDALL DEVINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
200 S ENOTA DR NE STE 100, GAINESVILLE, GA 30501-3466
(770) 534-2020
Mailing address
PO BOX 742616, ATLANTA, GA 30374-2616
(770) 219-8420
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
11446
GA
363A00000X
Physician Assistant
—
—
363AM0700X
Medical Physician Assistant
Primary
11446
GA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/24/2022
Last updated
04/11/2023
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