Healthcare Provider Details

I. General information

NPI: 1649084146
Provider Name (Legal Business Name): KIMBERLY GOSTON APC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2025
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14B GREENVILLE ST STE B3
NEWNAN GA
30263-2654
US

IV. Provider business mailing address

14B GREENVILLE ST STE B3
NEWNAN GA
30263-2654
US

V. Phone/Fax

Practice location:
  • Phone: 470-980-6816
  • Fax:
Mailing address:
  • Phone: 470-980-6816
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number009679
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: