Provider Demographics
NPI:1740893411
Name:SMITH, KIMBERLY VICTORIA (NP-C)
Entity type:Individual
Prefix:MISS
First Name:KIMBERLY
Middle Name:VICTORIA
Last Name:SMITH
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1035 SOUTHCREST DR STE 250
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-6117
Mailing Address - Country:US
Mailing Address - Phone:770-996-9945
Mailing Address - Fax:770-996-7355
Practice Address - Street 1:1035 SOUTHCREST DR STE 250
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-6117
Practice Address - Country:US
Practice Address - Phone:770-996-9945
Practice Address - Fax:770-996-7355
Is Sole Proprietor?:No
Enumeration Date:2020-08-24
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN201498363LP2300X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care