Individual
KIMBERLY FAIRCLOUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5950 ROSWELL RD, ATLANTA, GA 30328-4908
(000) 111-2222
Mailing address
5950 ROSWELL RD, ATLANTA, GA 30328-4908
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
RN247126
GA
Other
Enumeration date
11/02/2021
Last updated
01/29/2024
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