=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730349705
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KIMBERLY HERRIN COLE D.M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/13/2008
-----------------------------------------------------
Last Update Date | 01/13/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 MYRTLE BLVD
-----------------------------------------------------
City | GRACEWOOD
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30812
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-790-2144
-----------------------------------------------------
Fax | 706-790-2326
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3621 RIVERCREST RD
-----------------------------------------------------
City | AUGUSTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30907-9400
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-855-5993
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 10897
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------