Provider Demographics
NPI:1659519536
Name:CROM, KIMBERLY WILLIAMS (WHNP)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:WILLIAMS
Last Name:CROM
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 UPPER RIVERDALE ROAD
Mailing Address - Street 2:SUITE 135
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30274
Mailing Address - Country:US
Mailing Address - Phone:770-991-0778
Mailing Address - Fax:770-210-4430
Practice Address - Street 1:83 UPPER RIVERDALE ROAD
Practice Address - Street 2:SUITE 135
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30274
Practice Address - Country:US
Practice Address - Phone:770-991-0778
Practice Address - Fax:770-210-4430
Is Sole Proprietor?:No
Enumeration Date:2009-01-30
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN119083363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health