Healthcare Provider Details

I. General information

NPI: 1427448471
Provider Name (Legal Business Name): KIMBERLY KIMBLE RODRIGUEZ CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIMBERLY KIMBLE CRNA

II. Dates (important events)

Enumeration Date: 01/29/2015
Last Update Date: 01/22/2024
Certification Date: 01/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1984 PEACHTREE RD NW #515
ATLANTA GA
30309-5219
US

IV. Provider business mailing address

PO BOX 117535
ATLANTA GA
30368-7535
US

V. Phone/Fax

Practice location:
  • Phone: 404-351-1745
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number198249
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: