Provider Demographics
NPI:1295018372
Name:PAGE-DAVIS, KIMBERLY MICHELLE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:MICHELLE
Last Name:PAGE-DAVIS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 EDENHAM LN
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-7081
Mailing Address - Country:US
Mailing Address - Phone:404-731-6202
Mailing Address - Fax:
Practice Address - Street 1:2945 PANOLA RD
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30038-2313
Practice Address - Country:US
Practice Address - Phone:770-322-8486
Practice Address - Fax:770-322-7410
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-24
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH 022312183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist