Provider Demographics
NPI:1326830555
Name:MCKIBBEN, DEREK
Entity type:Individual
Prefix:
First Name:DEREK
Middle Name:
Last Name:MCKIBBEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375 SHILOH RD
Mailing Address - Street 2:
Mailing Address - City:JENKINSBURG
Mailing Address - State:GA
Mailing Address - Zip Code:30234-2422
Mailing Address - Country:US
Mailing Address - Phone:404-973-9763
Mailing Address - Fax:
Practice Address - Street 1:375 SHILOH RD
Practice Address - Street 2:
Practice Address - City:JENKINSBURG
Practice Address - State:GA
Practice Address - Zip Code:30234-2422
Practice Address - Country:US
Practice Address - Phone:404-973-9763
Practice Address - Fax:470-771-5123
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-22
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle