Healthcare Provider Details

I. General information

NPI: 1255972352
Provider Name (Legal Business Name): KIMBERLY KAY YAUGHN PHARM. D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2019
Last Update Date: 10/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 BRANNEN ST STE B
STATESBORO GA
30458-5184
US

IV. Provider business mailing address

2505 WATERINGHOLE CT
STATESBORO GA
30458-8671
US

V. Phone/Fax

Practice location:
  • Phone: 912-225-9279
  • Fax: 912-225-9284
Mailing address:
  • Phone: 912-536-1137
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH020447
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: