Provider Demographics
NPI:1851345235
Name:KIMBROUGH, STEPHEN MICHAEL (MD)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:MICHAEL
Last Name:KIMBROUGH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1321 SUNSET DRIVE
Mailing Address - Street 2:SUITE 11
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-7902
Mailing Address - Country:US
Mailing Address - Phone:423-928-6174
Mailing Address - Fax:423-926-2258
Practice Address - Street 1:1321 SUNSET DRIVE
Practice Address - Street 2:SUITE 11
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-7902
Practice Address - Country:US
Practice Address - Phone:423-928-6174
Practice Address - Fax:423-926-2258
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0125832084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
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