MEDICARE: KIMBERLY CARROLL MD

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	207V00000X	Obstetrics & Gynecology Physician	033047	GA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	202I167828	OTHER	GA	MEDICARE NUMBER

General Provider Information

NPI Number	:	1649270869
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY CARROLL MD

Provider Business Mailing Address
First Line	:	809 CLEVELAND AVE SW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30315-7108
Country	:	US
Telephone Number	:	404-767-2536
Fax Number	:	404-767-2779

Provider Business Practice Location Address
First Line	:	809 CLEVELAND AVE SW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30315-7108
Country	:	US
Telephone Number	:	404-767-2536
Fax Number	:	404-767-2779

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

Provider Enumeration Date	:	07/29/2005
Last Update Date	:	04/11/2022

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Directions to “ KIMBERLY CARROLL MD” Practice Location

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