Provider Demographics
NPI:1710737747
Name:LEGRONE, KIMBERLY D
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:D
Last Name:LEGRONE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:907 W 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31701-1713
Mailing Address - Country:US
Mailing Address - Phone:229-944-0326
Mailing Address - Fax:
Practice Address - Street 1:2620 DAWSON RD STE C
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31707-6678
Practice Address - Country:US
Practice Address - Phone:229-944-0326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA512171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist