Provider Demographics
NPI:1609401017
Name:LITTLE, KIMBERLY RENEE (RRT)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:RENEE
Last Name:LITTLE
Suffix:
Gender:F
Credentials:RRT
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:RENEE
Other - Last Name:LITTLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SMITH
Mailing Address - Street 1:196 BOB WHITE DR
Mailing Address - Street 2:
Mailing Address - City:HARTWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30643-4028
Mailing Address - Country:US
Mailing Address - Phone:706-371-3699
Mailing Address - Fax:
Practice Address - Street 1:196 BOB WHITE DR
Practice Address - Street 2:
Practice Address - City:HARTWELL
Practice Address - State:GA
Practice Address - Zip Code:30643-4028
Practice Address - Country:US
Practice Address - Phone:706-371-3699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-05
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA7640227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered