Provider Demographics
NPI:1134282114
Name:KIMES, DAMON C (MD)
Entity Type:Individual
Prefix:
First Name:DAMON
Middle Name:C
Last Name:KIMES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 UPPER HEMBREE RD STE B
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-0927
Mailing Address - Country:US
Mailing Address - Phone:678-736-7680
Mailing Address - Fax:888-537-5362
Practice Address - Street 1:1300 UPPER HEMBREE RD STE B
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-0927
Practice Address - Country:US
Practice Address - Phone:678-736-7680
Practice Address - Fax:888-537-5362
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA050322207P00000X
GAGA050322208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H08902Medicare UPIN