Active NPI
Anthony Lee Kicklighter, RPH.
- Pharmacist
- Saint Marys, GA
National Provider Identifier
1194027623
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 018501
- Practice address
- 214 Professional Cir Ste B
Saint Marys, GA 31558-3783 - Phone
- (912) 673-8220
- Fax
- (912) 673-7035
- NPI assigned
- Dec 4, 2010
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 018501 | GA | Primary |
Addresses
Primary practice location
214 Professional Cir Ste B
Saint Marys, GA 31558-3783
Mailing address
913 Seagrove St
Saint Marys, GA 31558-8516
Phone (912) 673-8220
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 018501 | GA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Camden Pharmacy Inc | Current | Accepting new patients | |
| Woodbine Medical, LLC | Past | Accepting new patients |
Locations
214 Professional Cir
Ste B
Saint Marys, GA 31558
Phone (912) 673-8220
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1291420800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1291420800000",
"number": "1194027623",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "913 SEAGROVE ST",
"city": "SAINT MARYS",
"state": "GA",
"postal_code": "315588516",
"telephone_number": "912-673-8220",
"fax_number": "912-673-7035"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "214 PROFESSIONAL CIR STE B",
"city": "SAINT MARYS",
"state": "GA",
"postal_code": "315583783",
"telephone_number": "912-673-8220",
"fax_number": "912-673-7035"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KICKLIGHTER",
"first_name": "ANTHONY",
"middle_name": "LEE",
"name_prefix": "Mr.",
"credential": "RPH.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-12-04",
"last_updated": "2010-12-04",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "GA",
"license": "018501",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Marys, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.