Provider Demographics
NPI:1801859830
Name:KIMBERLY J WINZER MD PC
Entity Type:Organization
Organization Name:KIMBERLY J WINZER MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:J
Authorized Official - Last Name:WINZER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-994-4060
Mailing Address - Street 1:6524 PROFESSIONAL PL
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30274-2520
Mailing Address - Country:US
Mailing Address - Phone:770-994-4060
Mailing Address - Fax:770-994-9435
Practice Address - Street 1:6524 PROFESSIONAL PL
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30274-2520
Practice Address - Country:US
Practice Address - Phone:770-994-4060
Practice Address - Fax:770-994-9435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA033258208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00596461LMedicaid
GAF83833Medicare UPIN