Provider Demographics
NPI:1619039583
Name:KIDWELL, MEREDITH ACH (PSC, CTRS)
Entity type:Individual
Prefix:MRS
First Name:MEREDITH
Middle Name:ACH
Last Name:KIDWELL
Suffix:
Gender:F
Credentials:PSC, CTRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 SETTLERS HAMMOCK CIR
Mailing Address - Street 2:
Mailing Address - City:SAINT SIMONS ISLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31522-8800
Mailing Address - Country:US
Mailing Address - Phone:912-269-6774
Mailing Address - Fax:912-634-6010
Practice Address - Street 1:104 SETTLERS HAMMOCK CIR
Practice Address - Street 2:
Practice Address - City:SAINT SIMONS ISLAND
Practice Address - State:GA
Practice Address - Zip Code:31522-8800
Practice Address - Country:US
Practice Address - Phone:912-269-6774
Practice Address - Fax:912-634-6010
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator