Provider Demographics
NPI:1184951600
Name:KIMSEY, ELICIA ARIEL PARVIN (PA-C)
Entity type:Individual
Prefix:
First Name:ELICIA
Middle Name:ARIEL PARVIN
Last Name:KIMSEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ELICIA
Other - Middle Name:ARIEL
Other - Last Name:PARVIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:420 E 2ND AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30161-3210
Mailing Address - Country:US
Mailing Address - Phone:706-509-3000
Mailing Address - Fax:
Practice Address - Street 1:48 HILLS CREEK RD
Practice Address - Street 2:
Practice Address - City:TAYLORSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30178-2051
Practice Address - Country:US
Practice Address - Phone:770-684-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-04
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA005723363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA551689539AMedicaid
GA551689539BMedicaid
GA551689539CMedicaid
GA551689539AMedicaid