Provider Demographics
NPI:1073503132
Name:LONG, KIMBERLEY L (CNM)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLEY
Middle Name:L
Last Name:LONG
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:699 CHURCH ST NE
Mailing Address - Street 2:SUITE 500
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-1110
Mailing Address - Country:US
Mailing Address - Phone:770-793-9750
Mailing Address - Fax:770-919-0581
Practice Address - Street 1:699 CHURCH ST NE
Practice Address - Street 2:SUITE 500
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1110
Practice Address - Country:US
Practice Address - Phone:770-793-9750
Practice Address - Fax:770-919-0581
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2016-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN114961367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife