Provider Demographics
NPI:1861637449
Name:CROSLAND, KIMBERLY BLAINE (MD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:BLAINE
Last Name:CROSLAND
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 1:10055 FORD AVE STE 4A
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:GA
Mailing Address - Zip Code:31324-3974
Mailing Address - Country:US
Mailing Address - Phone:912-527-5352
Mailing Address - Fax:912-756-5291
Practice Address - Street 1:10055 FORD AVE STE 4A
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:GA
Practice Address - Zip Code:31324-3974
Practice Address - Country:US
Practice Address - Phone:912-527-5352
Practice Address - Fax:912-756-5291
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-10
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA73501208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics