Healthcare Provider Details

I. General information

NPI: 1023073046
Provider Name (Legal Business Name): KIMBERLI H CARPENTER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 02/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 PERRY HWY
HAWKINSVILLE GA
31036-6748
US

IV. Provider business mailing address

PO BOX 1297
HAWKINSVILLE GA
31036-7297
US

V. Phone/Fax

Practice location:
  • Phone: 478-892-7246
  • Fax: 478-892-7247
Mailing address:
  • Phone: 478-892-7246
  • Fax: 478-892-7247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number054474
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: