Provider Demographics
NPI:1841831211
Name:KIMBLE, MYIA FRANCES (MA, PHLEBOTOMIST)
Entity type:Individual
Prefix:
First Name:MYIA
Middle Name:FRANCES
Last Name:KIMBLE
Suffix:
Gender:F
Credentials:MA, PHLEBOTOMIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3340 OAK DR SE
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013-2354
Mailing Address - Country:US
Mailing Address - Phone:770-881-7100
Mailing Address - Fax:770-828-0646
Practice Address - Street 1:4290 BELLS FERRY RD NW
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-7140
Practice Address - Country:US
Practice Address - Phone:770-899-7268
Practice Address - Fax:770-828-0646
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-07
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory