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General NPI Number Information
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NPI Number | 1013196377
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Entity Type | Organization
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Legal Business Name | SUZANNE KIMMONS, OD, PC
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Dates
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Enumeration Date | 11/02/2007
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Last Update Date | 03/20/2008
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Provider Practice Location Address
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Address Line | 6628 HIGHWAY 53 E
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City | DAWSONVILLE
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State | GA
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Zip | 30534-6806
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Country | US
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Telephone | 706-216-7732
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Fax | 706-216-7733
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Provider Business Mailing Address
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Address Line | 6628 HIGHWAY 53 E
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City | DAWSONVILLE
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State | GA
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Zip | 30534-6806
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Country | US
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Telephone | 706-216-7732
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Fax | 706-216-7733
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. SUZANNE KIMMONS-DOTY
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Credential | OD
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Telephone | 706-216-7732
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | T1164
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License Number State | GA
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