Provider Demographics
NPI:1457312019
Name:KIM, AMY E (MD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:E
Last Name:KIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:875 JOHNSON FERRY RD NE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1418
Mailing Address - Country:US
Mailing Address - Phone:404-257-9933
Mailing Address - Fax:404-257-9931
Practice Address - Street 1:875 JOHNSON FERRY RD NE
Practice Address - Street 2:SUITE 300
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1418
Practice Address - Country:US
Practice Address - Phone:404-257-9933
Practice Address - Fax:404-257-9931
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA048252207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA048252OtherSTATE LICENSE
GA048252OtherSTATE LICENSE
GAH88076Medicare UPIN
GA07BBSRMMedicare ID - Type UnspecifiedMEDICAR PROVIDER NUMBER