Provider Demographics
NPI:1265034243
Name:DOBSON, KIMBERLY SHAWN
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:SHAWN
Last Name:DOBSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 BELMONT PL SE UNIT 2415
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-2057
Mailing Address - Country:US
Mailing Address - Phone:678-984-5768
Mailing Address - Fax:
Practice Address - Street 1:1260 CONCORD RD SE STE 203
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-4380
Practice Address - Country:US
Practice Address - Phone:678-984-5768
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-13
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC011877101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional