1841831211 NPI number — MYIA FRANCES KIMBLE MA, PHLEBOTOMIST

Table of content: MYIA FRANCES KIMBLE MA, PHLEBOTOMIST (NPI 1841831211)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841831211 NPI number — MYIA FRANCES KIMBLE MA, PHLEBOTOMIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KIMBLE
Provider First Name:
MYIA
Provider Middle Name:
FRANCES
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA, PHLEBOTOMIST
Provider Gender Code:
F

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:
1841831211
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/12/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3340 OAK DR SE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CONYERS
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30013-2354
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-881-7100
Provider Business Mailing Address Fax Number:
770-828-0646

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4290 BELLS FERRY RD NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KENNESAW
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30144-7140
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-899-7268
Provider Business Practice Location Address Fax Number:
770-828-0646
Provider Enumeration Date:
10/07/2019

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: 291U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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