Provider Demographics
NPI:1184603029
Name:SOBOLIK, KIM ELISE (NP)
Entity type:Individual
Prefix:MRS
First Name:KIM
Middle Name:ELISE
Last Name:SOBOLIK
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:531 ROSELANE ST NW STE 710
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-6975
Mailing Address - Country:US
Mailing Address - Phone:678-331-3297
Mailing Address - Fax:678-581-7187
Practice Address - Street 1:340 KENNESTONE HOSPITAL BLVD STE 100
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1158
Practice Address - Country:US
Practice Address - Phone:770-281-5100
Practice Address - Fax:678-581-7100
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2019-06-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GARN138753363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1184603029OtherNPI NUMBER