Healthcare Provider Details

I. General information

NPI: 1548231681
Provider Name (Legal Business Name): KIMBERLY D HOFFMAN-GOODSON CRNPF MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 08/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1360 HEMBREE RD STE 100
ROSWELL GA
30076
US

IV. Provider business mailing address

1360 HEMBREE RD STE 100
ROSWELL GA
30076
US

V. Phone/Fax

Practice location:
  • Phone: 470-956-4430
  • Fax:
Mailing address:
  • Phone: 470-956-4430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024168814
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN276434
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: