Provider Demographics
NPI:1386763050
Name:CHUBB, KIMBERLY WILLIAMS (DMD)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:WILLIAMS
Last Name:CHUBB
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 72029
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30271-2029
Mailing Address - Country:US
Mailing Address - Phone:770-304-0034
Mailing Address - Fax:770-304-3439
Practice Address - Street 1:3229 HIGHWAY 34 E
Practice Address - Street 2:SUITE 101
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-2195
Practice Address - Country:US
Practice Address - Phone:770-304-0034
Practice Address - Fax:770-304-3439
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN011845122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA453005904DMedicaid