Provider Demographics
NPI:1023073723
Name:WILLIAMS, KIMBERLY THOMAS (MD)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:THOMAS
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:KAY
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:460 W MAIN ST
Mailing Address - Street 2:STE 100
Mailing Address - City:BLUE RIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30513-8566
Mailing Address - Country:US
Mailing Address - Phone:706-632-0330
Mailing Address - Fax:706-632-9004
Practice Address - Street 1:460 W MAIN ST
Practice Address - Street 2:STE 100
Practice Address - City:BLUE RIDGE
Practice Address - State:GA
Practice Address - Zip Code:30513-8566
Practice Address - Country:US
Practice Address - Phone:706-632-0330
Practice Address - Fax:706-632-9004
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA32063208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
H72549Medicare UPIN
GA37BBFXXMedicare ID - Type Unspecified