Provider Demographics
NPI:1437478047
Name:PICKENS, KIMBERLY E (MD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:E
Last Name:PICKENS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:15125 US HWY 19 S
Mailing Address - Street 2:PMB 380
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31792-4840
Mailing Address - Country:US
Mailing Address - Phone:229-236-6601
Mailing Address - Fax:229-236-6602
Practice Address - Street 1:504 GORDON AVE
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792-6646
Practice Address - Country:US
Practice Address - Phone:229-236-6601
Practice Address - Fax:229-236-6602
Is Sole Proprietor?:No
Enumeration Date:2010-05-21
Last Update Date:2020-08-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA067729207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine