MEDICARE: MR. KEVIN TOMBERLIN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	006760	GA

General Provider Information

NPI Number	:	1235567025
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KEVIN TOMBERLIN

Provider Business Mailing Address
First Line	:	29 HOLLY SPRINGS CIR
Second Line	:
City	:	PORT WENTWORTH
State	:	GA
Zip	:	31407-3608
Country	:	US
Telephone Number	:	912-247-2183
Fax Number	:

Provider Business Practice Location Address
First Line	:	6409 ABERCORN ST
Second Line	:
City	:	SAVANNAH
State	:	GA
Zip	:	31405-5715
Country	:	US
Telephone Number	:	912-356-1095
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/15/2013
Last Update Date	:	10/15/2013

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Directions to “ MR. KEVIN TOMBERLIN ” Practice Location

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