Provider Demographics
NPI:1063869352
Name:KIM, ANNA S (MD)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:S
Last Name:KIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3850 PLEASANT HILL RD
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-4807
Mailing Address - Country:US
Mailing Address - Phone:770-814-8222
Mailing Address - Fax:678-205-5111
Practice Address - Street 1:3850 PLEASANT HILL RD
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-4807
Practice Address - Country:US
Practice Address - Phone:770-814-8222
Practice Address - Fax:678-205-5111
Is Sole Proprietor?:No
Enumeration Date:2016-05-17
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD39251207N00000X
GAG39107A207N00000X, 207ND0101X
FLME149913207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL110609400Medicaid