Organization
DERRICK E KIMBLE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DERRICK E KIMBLE MED (CEO)
(706) 495-2351
Entity
Organization
Contact information
Practice address
2903 GALAHAD WAY, AUGUSTA, GA 30909-9147
(706) 495-2351
Mailing address
2903 GALAHAD WAY, AUGUSTA, GA 30909-9147
(706) 495-2351
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LPC005188
GA
251J00000X
Nursing Care Agency
RN107823
GA
Other
Enumeration date
12/13/2011
Last updated
12/13/2011
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