Basic Information
| Provider Information | |||||||||
| NPI: | 1225561996 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KIMBALL | ||||||||
| FirstName: | ASHLEY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 751 SPRING MEADOWS DR | ||||||||
| Address2: | |||||||||
| City: | RINGGOLD | ||||||||
| State: | GA | ||||||||
| PostalCode: | 307368989 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7735585056 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9005 OVERLOOK BLVD | ||||||||
| Address2: | |||||||||
| City: | BRENTWOOD | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370275269 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8453232610 | ||||||||
| FaxNumber: | 6468594440 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/09/2017 | ||||||||
| LastUpdateDate: | 11/05/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 1-17-27491 | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.