Provider Demographics
NPI:1588932685
Name:JERRY L. KITCHENS, JR., MD, PC
Entity type:Organization
Organization Name:JERRY L. KITCHENS, JR., MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:KITCHENS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:205-542-5139
Mailing Address - Street 1:2700 10TH AVE S
Mailing Address - Street 2:SUITE 510
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-1200
Mailing Address - Country:US
Mailing Address - Phone:205-542-5139
Mailing Address - Fax:
Practice Address - Street 1:2700 10TH AVE S
Practice Address - Street 2:SUITE 510
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-1200
Practice Address - Country:US
Practice Address - Phone:205-542-5139
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-05
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty