Healthcare Provider Details

I. General information

NPI: 1154154763
Provider Name (Legal Business Name): KIMBERLY E MILLER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2024
Last Update Date: 08/21/2024
Certification Date: 08/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2747 4TH ST # 101
BRUNSWICK GA
31520-3714
US

IV. Provider business mailing address

1076 AUTUMNS WOOD CIR E
BRUNSWICK GA
31525-5654
US

V. Phone/Fax

Practice location:
  • Phone: 912-264-3236
  • Fax: 912-264-0813
Mailing address:
  • Phone: 386-871-7337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN301070
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: