Provider Demographics
NPI:1427140664
Name:RASHADA, KIM B (MD)
Entity type:Individual
Prefix:DR
First Name:KIM
Middle Name:B
Last Name:RASHADA
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 1:3900 PERRY PASS
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30038-7729
Mailing Address - Country:US
Mailing Address - Phone:386-473-6300
Mailing Address - Fax:
Practice Address - Street 1:2130 W SYCAMORE ST STE 140
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46901-6463
Practice Address - Country:US
Practice Address - Phone:765-456-5611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY45799207V00000X
IN01054087A207V00000X
FLME93295207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL274005200Medicaid
IN1427140664OtherNPI
FL274005200Medicaid
FLU6561ZMedicare PIN