Healthcare Provider Details

I. General information

NPI: 1053589192
Provider Name (Legal Business Name): KIMBERLY L. BROWN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2008
Last Update Date: 08/30/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 PIEDMONT AVE SE STE 1502
ATLANTA GA
30334-9027
US

IV. Provider business mailing address

106 LOUISIANA DR
VIDALIA GA
30474-6130
US

V. Phone/Fax

Practice location:
  • Phone: 470-597-7158
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN163310
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: