Individual
MS. KIMBERLY HARRIS NIX
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
100 MIMOSA DRIVE, SUITE 1R, THOMASVILLE, GA 31792-6678
(229) 226-9141
(229) 228-0637
Mailing address
100 MIMOSA DRIVE, SUITE 1R, THOMASVILLE, GA 31792-6678
(229) 226-9141
(229) 228-0637
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
005044
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
891063020F
—
GA
05
—
891063020G
—
GA
05
—
891063020H
—
GA
01
—
GRP318
MEDICARE GROUP PTAN
GA
Enumeration date
04/23/2007
Last updated
02/21/2012
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