=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801859830
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KIMBERLY J WINZER MD PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/10/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6524 PROFESSIONAL PL
-----------------------------------------------------
City | RIVERDALE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30274-2520
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-994-4060
-----------------------------------------------------
Fax | 770-994-9435
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6524 PROFESSIONAL PL
-----------------------------------------------------
City | RIVERDALE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30274-2520
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-994-4060
-----------------------------------------------------
Fax | 770-994-9435
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | KIMBERLY J WINZER
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 770-994-4060
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | 033258
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------