Provider Demographics
NPI:1215238639
Name:HASBACH, KIMBERLY K
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:K
Last Name:HASBACH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11029 WARM SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31820-4910
Mailing Address - Country:US
Mailing Address - Phone:706-562-1967
Mailing Address - Fax:
Practice Address - Street 1:7901 VETERANS PKWY
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31909-1723
Practice Address - Country:US
Practice Address - Phone:706-321-1223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-17
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN178427 NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily