Provider Demographics
NPI:1114694460
Name:KIMBLE CARE MEDICAL SERVICES
Entity Type:Organization
Organization Name:KIMBLE CARE MEDICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:MYIA
Authorized Official - Middle Name:
Authorized Official - Last Name:KIMBLE
Authorized Official - Suffix:
Authorized Official - Credentials:CPI/MA/AEMT
Authorized Official - Phone:770-899-7268
Mailing Address - Street 1:3340 OAK DR SE
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013-2354
Mailing Address - Country:US
Mailing Address - Phone:770-899-7268
Mailing Address - Fax:
Practice Address - Street 1:3340 OAK DR SE
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013-2354
Practice Address - Country:US
Practice Address - Phone:770-881-7100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-25
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care