Provider Demographics
NPI:1346253200
Name:HART, KIMBERLY WOMACK (CPNP)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:WOMACK
Last Name:HART
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:LEANNE
Other - Last Name:WOMACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:735 GLYNN STREET SOUTH
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214
Mailing Address - Country:US
Mailing Address - Phone:770-461-4126
Mailing Address - Fax:
Practice Address - Street 1:735 GLYNN STREET SOUTH
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214
Practice Address - Country:US
Practice Address - Phone:770-461-4126
Practice Address - Fax:404-785-8574
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN119459208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics