Individual
DR. HEAVENLY KIMES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3240 GLENCREE ROAD, CONYERS, GA 30012-1167
(404) 713-4982
(678) 413-2491
Mailing address
3240 GLENCCREE ROAD, CONYERS, GA 30012-1167
(678) 413-3184
(678) 413-2491
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN012304
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000898015A
—
GA
05
—
000898015B
—
GA
05
—
000898015C
—
GA
Enumeration date
01/04/2007
Last updated
05/15/2008
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