Individual
JENNIFER LEE KIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1000 CORPORATE CENTER DR, SUITE 100, MORROW, GA 30260-4180
(770) 968-8888
(770) 960-2473
Mailing address
1000 CORPORATE CENTER DR, SUITE 100, MORROW, GA 30260-4180
(770) 968-8888
(770) 960-2473
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
074038
GA
207W00000X
Ophthalmology Physician
38366
SC
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003181756A
—
GA
01
—
581787543
EYE CARE CENTERS MANAGEMENT, INC. D/B/A CLAYTON EYE CENTER
—
Enumeration date
04/07/2011
Last updated
12/11/2018
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