Provider Demographics
NPI:1457752560
Name:MILLIKEN, KIMBERLY
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:MILLIKEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:A
Other - Last Name:MILLIKEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:SLP
Mailing Address - Street 1:4319 S LEE ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30518-5747
Mailing Address - Country:US
Mailing Address - Phone:770-402-3403
Mailing Address - Fax:770-402-3403
Practice Address - Street 1:4319 S LEE ST
Practice Address - Street 2:SUITE 300
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30518-5747
Practice Address - Country:US
Practice Address - Phone:770-402-3403
Practice Address - Fax:770-402-3403
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-08
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP007244235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist