Provider Demographics
NPI:1932088762
Name:GRIFFARD, KIMBERLY (LMT)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:GRIFFARD
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 HAWKS TAIL DR
Mailing Address - Street 2:
Mailing Address - City:KATHLEEN
Mailing Address - State:GA
Mailing Address - Zip Code:31047-2741
Mailing Address - Country:US
Mailing Address - Phone:478-777-4495
Mailing Address - Fax:
Practice Address - Street 1:104 CONSTITUTION DR
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-7889
Practice Address - Country:US
Practice Address - Phone:478-333-2663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-27
Last Update Date:2025-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT007926225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist