Provider Demographics
NPI:1790731867
Name:HARBIN, KIMBERLY A (MD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:A
Last Name:HARBIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 1ST AVE NE
Mailing Address - Street 2:
Mailing Address - City:CAIRO
Mailing Address - State:GA
Mailing Address - Zip Code:39828-2118
Mailing Address - Country:US
Mailing Address - Phone:229-378-2214
Mailing Address - Fax:229-246-9322
Practice Address - Street 1:235 1ST AVE NE
Practice Address - Street 2:
Practice Address - City:CAIRO
Practice Address - State:GA
Practice Address - Zip Code:39828-2118
Practice Address - Country:US
Practice Address - Phone:229-378-2214
Practice Address - Fax:229-246-9322
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-26
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA050087207P00000X
GU050087207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000954412AMedicaid
GA050087OtherMEDICAL LICENSE
GA000954412AMedicaid
GA050087OtherMEDICAL LICENSE