Provider Demographics
NPI:1508546979
Name:KIDD, CHLOE (NP)
Entity Type:Individual
Prefix:
First Name:CHLOE
Middle Name:
Last Name:KIDD
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 1:145 HOLLY HILLS DR
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-3282
Mailing Address - Country:US
Mailing Address - Phone:706-809-2320
Mailing Address - Fax:
Practice Address - Street 1:2205 BARNETT SHOALS RD
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30605-3605
Practice Address - Country:US
Practice Address - Phone:706-548-1555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-20
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN277281363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily