MEDICARE: KIMBERLEY RHODES HAM M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	050375	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629162219
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLEY RHODES HAM M.D.

Provider Business Mailing Address
First Line	:	2510 HWY 127
Second Line	:	HOUSTON LAKE MEDSTOP
City	:	KATHLEEN
State	:	GA
Zip	:	31047
Country	:	US
Telephone Number	:	478-975-6800
Fax Number	:	478-975-6814

Provider Business Practice Location Address
First Line	:	2510 HWY 127
Second Line	:	HOUSTON LAKE MEDSTOP
City	:	KATHLEEN
State	:	GA
Zip	:	31047
Country	:	US
Telephone Number	:	478-975-6800
Fax Number	:	478-975-6814

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	02/16/2015

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Directions to “ KIMBERLEY RHODES HAM M.D.” Practice Location

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