Provider Demographics
NPI:1437188257
Name:KIFF, JONATHAN PAUL (PA-C)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:PAUL
Last Name:KIFF
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:999 S MACON ST
Mailing Address - Street 2:
Mailing Address - City:JESUP
Mailing Address - State:GA
Mailing Address - Zip Code:31545-0240
Mailing Address - Country:US
Mailing Address - Phone:912-385-2732
Mailing Address - Fax:
Practice Address - Street 1:999 S MACON ST
Practice Address - Street 2:
Practice Address - City:JESUP
Practice Address - State:GA
Practice Address - Zip Code:31545-0240
Practice Address - Country:US
Practice Address - Phone:912-385-2732
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004801363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA117114997DMedicaid
202I972956OtherMEDICARE PTAN NUMBER
GA202I977421Medicare PIN