Provider Demographics
NPI:1841569993
Name:TERRELL, KIMBERLY V (RD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:V
Last Name:TERRELL
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5303 VAUGHN RD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36116-1120
Mailing Address - Country:US
Mailing Address - Phone:334-386-0378
Mailing Address - Fax:337-386-0382
Practice Address - Street 1:196 RIDGECREST CIR
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:GA
Practice Address - Zip Code:30525-4111
Practice Address - Country:US
Practice Address - Phone:706-782-4233
Practice Address - Fax:706-782-6451
Is Sole Proprietor?:No
Enumeration Date:2011-12-19
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD002241133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered