Provider Demographics
NPI:1750608972
Name:KIM, ANNIE (MD)
Entity type:Individual
Prefix:DR
First Name:ANNIE
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ANNIE
Other - Middle Name:KIM
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:900 TOWNE LAKE PKWY
Mailing Address - Street 2:STE 404
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30189-1604
Mailing Address - Country:US
Mailing Address - Phone:770-926-9229
Mailing Address - Fax:678-445-2164
Practice Address - Street 1:10515 BELLS FERRY RD
Practice Address - Street 2:SUITE 200
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-4204
Practice Address - Country:US
Practice Address - Phone:770-720-8551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-27
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA71538207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology