Provider Demographics
NPI:1629606223
Name:THOMPSON, KIMBERLY OTIS (MSW)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:OTIS
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MISS
Other - First Name:KIMBERLY
Other - Middle Name:JO
Other - Last Name:OTIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:120 E TRINITY PL
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-3302
Mailing Address - Country:US
Mailing Address - Phone:404-378-2300
Mailing Address - Fax:404-378-2394
Practice Address - Street 1:120 E TRINITY PL
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-3302
Practice Address - Country:US
Practice Address - Phone:404-378-2300
Practice Address - Fax:404-378-2394
Is Sole Proprietor?:No
Enumeration Date:2020-03-30
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical