Provider Demographics
NPI:1508000738
Name:DILLARD, KIMBERLY FAITH (NP)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:FAITH
Last Name:DILLARD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:543 JONESBORO RD
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-3718
Mailing Address - Country:US
Mailing Address - Phone:678-583-9071
Mailing Address - Fax:678-583-9319
Practice Address - Street 1:543 JONESBORO RD
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-3718
Practice Address - Country:US
Practice Address - Phone:678-583-9071
Practice Address - Fax:678-583-9319
Is Sole Proprietor?:No
Enumeration Date:2009-05-01
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN149811NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner