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General NPI Number Information
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NPI Number | 1114074192
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Entity Type | Individual
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Provider Name | DR. HEAVENLY KIMES
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Gender | Female
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Dates
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Enumeration Date | 01/04/2007
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Last Update Date | 05/15/2008
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Provider Practice Location Address
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Address Line | 3240 GLENCREE ROAD
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City | CONYERS
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State | GA
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Zip | 30012-1167
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Country | US
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Telephone | 404-713-4982
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Fax | 678-413-2491
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Provider Business Mailing Address
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Address Line | 3240 GLENCCREE ROAD
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City | CONYERS
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State | GA
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Zip | 30012-1167
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Country | US
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Telephone | 678-413-3184
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Fax | 678-413-2491
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN012304
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License Number State | GA
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