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: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3708 NORTHSIDE DR BLDG A
MACON GA
31210-2404
US

IV. Provider business mailing address

127 RIVER VALLEY TRL
KATHLEEN GA
31047-2139
US

V. Phone/Fax

Practice location:
  • Phone: 478-254-5415
  • Fax:
Mailing address:
  • Phone: 912-381-4148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number054474
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number54474
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: