Provider Demographics
NPI:1316376890
Name:FAIR, KIMDI JOY (DC)
Entity Type:Individual
Prefix:DR
First Name:KIMDI
Middle Name:JOY
Last Name:FAIR
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89 LIGHTHOUSE DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:GA
Mailing Address - Zip Code:30132-1026
Mailing Address - Country:US
Mailing Address - Phone:678-770-0818
Mailing Address - Fax:
Practice Address - Street 1:110 EVANS MILL DR
Practice Address - Street 2:SUITE 105
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30157-1622
Practice Address - Country:US
Practice Address - Phone:770-485-6955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-05
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIRO07494111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor