Provider Demographics
NPI:1558819052
Name:WINTERS, KIMBERLY J (MSN)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:J
Last Name:WINTERS
Suffix:
Gender:F
Credentials:MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2030 POWERS FERRY RD SE STE 120
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-5016
Mailing Address - Country:US
Mailing Address - Phone:678-801-2329
Mailing Address - Fax:844-249-2637
Practice Address - Street 1:304 JACOBS HWY
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:SC
Practice Address - Zip Code:29325-7279
Practice Address - Country:US
Practice Address - Phone:864-833-2550
Practice Address - Fax:864-938-9240
Is Sole Proprietor?:No
Enumeration Date:2016-09-14
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20364363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC20364OtherSTATE LICENSE NUMBER