Provider Demographics
NPI:1649519398
Name:SLIGH, KIMBERLY SMITH (RPH)
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:SMITH
Last Name:SLIGH
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:ELAINE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:206 WATERVALE RD
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:GA
Mailing Address - Zip Code:30907-9001
Mailing Address - Country:US
Mailing Address - Phone:706-860-2560
Mailing Address - Fax:
Practice Address - Street 1:2816 WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-2199
Practice Address - Country:US
Practice Address - Phone:706-731-5206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-31
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA014944183500000X
SC12497183500000X
IL051293340183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist