Provider Demographics
NPI:1386024792
Name:WHITWORTH, KIMBERLY ROYALE STUBBS (MD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ROYALE STUBBS
Last Name:WHITWORTH
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 1:5635 PEACHTREE PKWY STE 180
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-2823
Mailing Address - Country:US
Mailing Address - Phone:470-938-6670
Mailing Address - Fax:
Practice Address - Street 1:5635 PEACHTREE PKWY STE 180
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30092-2823
Practice Address - Country:US
Practice Address - Phone:470-938-6670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-02
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA843582084P0802X, 2084P0800X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction PsychiatryGroup - Single Specialty