Provider Demographics
NPI:1558685545
Name:KILBOURNE, EDWIN MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:MICHAEL
Last Name:KILBOURNE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5658 MILL TRACE DR
Mailing Address - Street 2:
Mailing Address - City:DUNWOODY
Mailing Address - State:GA
Mailing Address - Zip Code:30338-2730
Mailing Address - Country:US
Mailing Address - Phone:404-496-4909
Mailing Address - Fax:
Practice Address - Street 1:5658 MILL TRACE DR
Practice Address - Street 2:
Practice Address - City:DUNWOODY
Practice Address - State:GA
Practice Address - Zip Code:30338-2730
Practice Address - Country:US
Practice Address - Phone:404-496-4909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-18
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA303332083T0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083T0002XAllopathic & Osteopathic PhysiciansPreventive MedicineMedical Toxicology