Andrea M Thaxton, MD
Individual provider Active NPI Pediatrics Physician · Kings Bay, GA
NPI 1528067337 · NPPES record last updated Aug 17, 2023
Key facts
- NPI
- 1528067337
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- ME88475 (FL)
- Practice address
- 881 Uss James Madison Rd
Kings Bay, GA 31547-2531 - Phone
- (912) 573-4220
- Fax
- (912) 573-2597
- NPI assigned
- Jul 14, 2005
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ME88475 | FL | MD | Pediatrics Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | ME88475 | FL | Yes |
Addresses
Primary practice location
881 Uss James Madison Rd
Kings Bay, GA 31547-2531
Mailing address
881 Uss James Madison Rd
Kings Bay, GA 31547-2531
Phone (912) 573-8801
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 267766100 | Medicaid | FL |
Other providers in Kings Bay, GA
- Mark Timothy Sizemore
- Hillary Constance Smith
- John Hugh Steely
- Kristin Sthole
- Stephanie Denise Sulewski
- Gregory Lee Watford
- Andrew Thomas Wemlinger
- Allan Whitney
- Richard Benjamin Wilhite
- Stacey Wilkins
All providers in Kings Bay, GA · Pediatrics Physician in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 17, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.