Provider Demographics
NPI:1093760217
Name:NEISLER, KIM VU (MD)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:VU
Last Name:NEISLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:960 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-7345
Mailing Address - Country:US
Mailing Address - Phone:678-251-1099
Mailing Address - Fax:
Practice Address - Street 1:960 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-7345
Practice Address - Country:US
Practice Address - Phone:678-251-1099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2013-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA562392085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA900520OtherBCBS
GA945221OtherBCBS
GA92BBFXDMedicare ID - Type Unspecified
GA92BBFWXMedicare ID - Type Unspecified
GA92BBFXBMedicare ID - Type Unspecified
GA945221OtherBCBS
GAP00274322Medicare ID - Type UnspecifiedRAILROAD
GA92BBFWZMedicare ID - Type Unspecified