Healthcare Provider Details

I. General information

NPI: 1326269598
Provider Name (Legal Business Name): KIDS FIRST PEDIATRICS OF GEORGIA, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 07/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

143 CANAL ST SUITE 200
POOLER GA
31322-6007
US

IV. Provider business mailing address

PO BOX 668
POOLER GA
31322-0668
US

V. Phone/Fax

Practice location:
  • Phone: 912-748-4527
  • Fax: 912-748-9016
Mailing address:
  • Phone: 912-748-4527
  • Fax: 912-748-9016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. KAREN MICHELLE KIM
Title or Position: CEO
Credential: M.D.
Phone: 912-748-4527