Healthcare Provider Details

I. General information

NPI: 1316074412
Provider Name (Legal Business Name): KIMBERLEY ANNE LINERT OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 08/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2320 ATLANTA HWY
CUMMING GA
30040-6339
US

IV. Provider business mailing address

525 TRIBBLE GAP RD #1305
CUMMING GA
30028-2937
US

V. Phone/Fax

Practice location:
  • Phone: 678-965-5558
  • Fax:
Mailing address:
  • Phone: 678-965-5558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number001285
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: