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General NPI Number Information
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NPI Number | 1174626543
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Entity Type | Individual
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Provider Name | RICHARD WILLIAM KIMMERLING MD
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Gender | Male
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Dates
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Enumeration Date | 09/07/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 5610 FORKWOOD DR NW
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City | ACWORTH
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State | GA
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Zip | 30101-8023
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Country | US
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Telephone | 770-590-8915
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Fax | 770-218-0998
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Provider Business Mailing Address
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Address Line | 5610 FORKWOOD DR NW
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City | ACWORTH
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State | GA
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Zip | 30101-8023
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Country | US
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Telephone | 770-590-8915
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Fax | 770-218-0998
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 11710
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License Number State | GA
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