1154304889 NPI number — CHAD JEROME KIMBROUGH DDS

Table of content: CHAD JEROME KIMBROUGH DDS (NPI 1154304889)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154304889 NPI number — CHAD JEROME KIMBROUGH DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KIMBROUGH
Provider First Name:
CHAD
Provider Middle Name:
JEROME
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154304889
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/21/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 6216A
Provider Second Line Business Mailing Address:
NAVAL HOSPITAL BEAUFORT, ATTN: PROF AFFAIRS COORDINATOR
Provider Business Mailing Address City Name:
BEAUFORT
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29902-6148
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-228-5577
Provider Business Mailing Address Fax Number:
843-228-5196

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
992 GATEWAY COMMONS CIR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAKE FOREST
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27587-6594
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
984-302-7665
Provider Business Practice Location Address Fax Number:
843-228-5196
Provider Enumeration Date:
11/28/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  9593 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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