Provider Demographics
NPI:1801979398
Name:TURNER, KIMBERLY STANCIL (MD)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:STANCIL
Last Name:TURNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:ELAINE
Other - Last Name:STANCIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 671
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:GA
Mailing Address - Zip Code:30655-0671
Mailing Address - Country:US
Mailing Address - Phone:770-267-7093
Mailing Address - Fax:770-267-7361
Practice Address - Street 1:521 GREAT OAKS DRIVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:GA
Practice Address - Zip Code:30655
Practice Address - Country:US
Practice Address - Phone:770-267-7093
Practice Address - Fax:770-267-7361
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA050066207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00901865AMedicaid
GA00901865AMedicaid
GA08BBVFZMedicare PIN