Provider Demographics
NPI:1407628118
Name:REID, KIMBERLY T
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:T
Last Name:REID
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7297 GINGER CT
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30296-3309
Mailing Address - Country:US
Mailing Address - Phone:770-282-0866
Mailing Address - Fax:
Practice Address - Street 1:7297 GINGER CT
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30296-3309
Practice Address - Country:US
Practice Address - Phone:770-282-0866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-25
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health