Provider Demographics
NPI:1992749659
Name:KINGMAN, AMY D (MD)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:D
Last Name:KINGMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:682 HEMLOCK ST
Mailing Address - Street 2:SUITE 490
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-8307
Mailing Address - Country:US
Mailing Address - Phone:478-741-1208
Mailing Address - Fax:478-741-1557
Practice Address - Street 1:682 HEMLOCK ST
Practice Address - Street 2:SUITE 490
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-8307
Practice Address - Country:US
Practice Address - Phone:478-741-1208
Practice Address - Fax:478-741-1557
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA002870207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA936764307AMedicaid
GA06BDHGGMedicare ID - Type Unspecified
GA936764307AMedicaid