Provider Demographics
NPI:1285839803
Name:MCGILL, KIMBERLY MICHELLE (MD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:MICHELLE
Last Name:MCGILL
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 1:300 MEDICAL PAVILION DR
Mailing Address - Street 2:
Mailing Address - City:RAEFORD
Mailing Address - State:NC
Mailing Address - Zip Code:28376-0019
Mailing Address - Country:US
Mailing Address - Phone:910-904-8035
Mailing Address - Fax:910-615-9752
Practice Address - Street 1:300 MEDICAL PAVILION DR
Practice Address - Street 2:
Practice Address - City:RAEFORD
Practice Address - State:NC
Practice Address - Zip Code:28376-0019
Practice Address - Country:US
Practice Address - Phone:910-904-8035
Practice Address - Fax:910-615-9752
Is Sole Proprietor?:No
Enumeration Date:2007-06-15
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT191581207V00000X
NC2014-01780207V00000X
NMMD2011-0232207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology