Individual
DR. BLAKE STEVEN KIMBRELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
150 NACOOCHEE AVE, ATHENS, GA 30601-1823
(706) 546-7908
(706) 546-1944
Mailing address
150 NACOOCHEE AVE, ATHENS, GA 30601-1823
(706) 546-7908
(706) 546-1944
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
0101258556
VA
207Y00000X
Otolaryngology Physician
262561
MA
207Y00000X
Otolaryngology Physician
Primary
75683
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003176590A
—
GA
Enumeration date
04/05/2010
Last updated
06/07/2021
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