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General NPI Number Information
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NPI Number | 1174181911
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Entity Type | Individual
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Provider Name | DENISE M KIMBROUGH MD, PHD
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Gender | Female
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Dates
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Enumeration Date | 06/05/2019
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Last Update Date | 05/24/2024
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Provider Practice Location Address
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Address Line | 169 ASHLEY AVENUE ROOM 202 MAIN HOSPITAL MSC333
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City | CHARLESTON
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State | SC
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Zip | 29425
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Country | US
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Telephone | 843-792-0435
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Fax |
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Provider Business Mailing Address
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Address Line | 5001 OLENTANGY RIVER RD APT 139
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City | COLUMBUS
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State | OH
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Zip | 43214-1356
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Country | US
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Telephone | 205-585-3097
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Fax |
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 35.147946
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | LL82599
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License Number State | SC
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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | LL82599
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License Number State | SC
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Taxonomy #4
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 35.147946
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License Number State | OH
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