Healthcare Provider Details

I. General information

NPI: 1285620450
Provider Name (Legal Business Name): KIMBERLY M KURTZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 S CHESTATEE
DAHLONEGA GA
30533-5503
US

IV. Provider business mailing address

1300 S CHESTATEE
DAHLONEGA GA
30533-5503
US

V. Phone/Fax

Practice location:
  • Phone: 706-867-6005
  • Fax: 706-867-6012
Mailing address:
  • Phone: 706-867-6005
  • Fax: 706-867-6012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number050815
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: