Provider Demographics
NPI:1285036467
Name:AKINS, KELLI
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:
Last Name:AKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1409
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30459-1409
Mailing Address - Country:US
Mailing Address - Phone:912-764-6188
Mailing Address - Fax:912-489-8937
Practice Address - Street 1:26 W GRADY ST
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-2742
Practice Address - Country:US
Practice Address - Phone:912-764-6188
Practice Address - Fax:912-489-8937
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-19
Last Update Date:2014-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA016-02146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000263227AMedicaid
GA000263227AMedicaid