Provider Demographics
NPI:1659315232
Name:REEVES, KIMBERLY MILLIGAN (NP)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:MILLIGAN
Last Name:REEVES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:
Other - Last Name:MILLIGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 116336
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368-6336
Mailing Address - Country:US
Mailing Address - Phone:912-352-8346
Mailing Address - Fax:912-355-1414
Practice Address - Street 1:4750 WATERS AVE
Practice Address - Street 2:SUITE 500
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31404-6200
Practice Address - Country:US
Practice Address - Phone:912-352-8346
Practice Address - Fax:912-355-1414
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN067191363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003100265DMedicaid
GA000741848GMedicaid
GA003100265CMedicaid
GA582162071026OtherCHAMPUS
SCNP1694Medicaid
GA003100265AMedicaid
GA202I504893Medicare PIN
GAP00894973Medicare PIN
GAS54233Medicare UPIN
GA000741848GMedicaid