Individual
KIMBERLEY P SHANKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D
Contact information
Practice address
2510 LIMESTONE PKWY, GAINESVILLE, GA 30501-2089
(770) 534-9933
(770) 594-8999
Mailing address
PO BOX 742616, ATLANTA, GA 30374-2616
(770) 219-8420
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
057840
GA
207KA0200X
Allergy Physician
057840
GA
2080P0201X
Pediatric Allergy/Immunology Physician
057840
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
242084536C
—
GA
01
—
58I030003
MEDICARE
GA
Enumeration date
07/22/2006
Last updated
10/06/2020
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