Healthcare Provider Details

I. General information

NPI: 1750640157
Provider Name (Legal Business Name): ZACHARY JAMES KIMBALL MD, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2012
Last Update Date: 06/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 N CENTER ST STE 201
HICKORY NC
28601-5036
US

IV. Provider business mailing address

415 N CENTER ST STE 201
HICKORY NC
28601-5036
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-5956
  • Fax: 859-323-1080
Mailing address:
  • Phone: 859-323-5956
  • Fax: 859-323-1080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number201600190
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: