MEDICARE: MISS KALIMA E REMBERT PP

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	171W00000X	Contractor		GA

General Provider Information

NPI Number	:	1831659176
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS KALIMA E REMBERT PP

Provider Business Mailing Address
First Line	:	200 LEE ROAD 2126
Second Line	:
City	:	SALEM
State	:	AL
Zip	:	36874-2161
Country	:	US
Telephone Number	:	334-332-9278
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 LEE ROAD 2126
Second Line	:
City	:	SALEM
State	:	AL
Zip	:	36874-2161
Country	:	US
Telephone Number	:	334-332-9278
Fax Number	:

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

Provider Enumeration Date	:	03/22/2019
Last Update Date	:	03/22/2019

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Directions to “ MISS KALIMA E REMBERT PP” Practice Location

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