Provider Demographics
NPI:1356651210
Name:LINDSAY, KIMBERLY (PA-C)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:
Last Name:LINDSAY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:KATHRYN
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:3780 HOLCOMB BRIDGE RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-4855
Mailing Address - Country:US
Mailing Address - Phone:770-263-9101
Mailing Address - Fax:770-263-9101
Practice Address - Street 1:3780 HOLCOMB BRIDGE RD
Practice Address - Street 2:SUITE C
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30092-4855
Practice Address - Country:US
Practice Address - Phone:770-263-9101
Practice Address - Fax:770-263-9101
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-13
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA6388363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003135562BMedicaid