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General NPI Number Information
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NPI Number | 1417620345
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Entity Type | Individual
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Provider Name | MR. MELVIN G KIMBLE
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Gender | Male
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Dates
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Enumeration Date | 07/27/2021
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Last Update Date | 03/30/2022
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Provider Practice Location Address
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Address Line | 120 ZACK CIR
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City | ELIZABETH CTY
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State | NC
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Zip | 27909-9617
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Country | US
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Telephone | 252-207-1166
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Fax |
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Provider Business Mailing Address
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Address Line | 120 ZACK CIR
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City | ELIZABETH CITY
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State | NC
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Zip | 27909-9617
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Country | US
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Telephone | 252-207-1166
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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 | 172A00000X
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Taxonomy Name | Driver
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License Number | 42700532
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License Number State |
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