Provider Demographics
NPI:1508972258
Name:KIM OPPENHEIMER, PHD, PC
Entity Type:Organization
Organization Name:KIM OPPENHEIMER, PHD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KIM
Authorized Official - Middle Name:C
Authorized Official - Last Name:OPPENHEIMER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:404-847-9560
Mailing Address - Street 1:1100 JOHNSON FERRY RD NE
Mailing Address - Street 2:BLDG 2, SUITE 1090
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1709
Mailing Address - Country:US
Mailing Address - Phone:404-847-9560
Mailing Address - Fax:404-847-9537
Practice Address - Street 1:1100 JOHNSON FERRY RD NE
Practice Address - Street 2:BLDG 2, SUITE 1090
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1709
Practice Address - Country:US
Practice Address - Phone:404-847-9560
Practice Address - Fax:404-847-9537
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1099103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
68BBDKZMedicare PIN