Provider Demographics
NPI:1457411605
Name:CARR, KIMBERLY (MD)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:
Last Name:CARR
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 1:2135 EASTVIEW PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013-5771
Mailing Address - Country:US
Mailing Address - Phone:770-918-8099
Mailing Address - Fax:770-918-8402
Practice Address - Street 1:2135 EASTVIEW PKWY STE 100
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013-5771
Practice Address - Country:US
Practice Address - Phone:770-918-8099
Practice Address - Fax:770-918-8402
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA052062208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA782382212JMedicaid
GAH78580Medicare UPIN
GA37BBGKLMedicare ID - Type Unspecified