Provider Demographics
NPI:1881838225
Name:MILLSAP, KIMBERLY DAWN (CNM)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:DAWN
Last Name:MILLSAP
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:MILLSAP
Other - Last Name:WOMACK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CNM
Mailing Address - Street 1:221 TECHNOLOGY PKWY NW
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165-1369
Mailing Address - Country:US
Mailing Address - Phone:762-235-1000
Mailing Address - Fax:
Practice Address - Street 1:200 GENTILLY BLVD
Practice Address - Street 2:
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120-8504
Practice Address - Country:US
Practice Address - Phone:470-490-7200
Practice Address - Fax:770-276-7251
Is Sole Proprietor?:No
Enumeration Date:2009-04-29
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN178269367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA788128026DMedicaid
GA788128026BMedicaid
GA788128026CMedicaid
GA788128026DMedicaid