Healthcare Provider Details

I. General information

NPI: 1033930938
Provider Name (Legal Business Name): KIMBERLY PUZIO MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2024
Last Update Date: 10/23/2024
Certification Date: 10/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 W COLLEGE ST STE D
GRIFFIN GA
30224-4249
US

IV. Provider business mailing address

31 TEAL CT
LOCUST GROVE GA
30248-2423
US

V. Phone/Fax

Practice location:
  • Phone: 678-688-3133
  • Fax:
Mailing address:
  • Phone: 229-938-9165
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number101YM0800X
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: