Basic Information
| Provider Information | |||||||||
| NPI: | 1255521803 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JAMES | ||||||||
| FirstName: | KIMONE | ||||||||
| MiddleName: | MONET | ||||||||
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| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 55 WHITCHER ST NE | ||||||||
| Address2: | SUITE 460 | ||||||||
| City: | MARIETTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300601155 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7704277389 | ||||||||
| FaxNumber: | 7704271492 | ||||||||
| Practice Location | |||||||||
| Address1: | 55 WHITCHER ST NE | ||||||||
| Address2: | SUITE 460 | ||||||||
| City: | MARIETTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300601155 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7704277389 | ||||||||
| FaxNumber: | 7704271492 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/30/2007 | ||||||||
| LastUpdateDate: | 08/01/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 2010-02114 | NC | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | MD.201527 | LA | N | Allopathic & Osteopathic Physicians | Hospitalist | 207RN0300X | 67477 | GA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
| ID | Type | State | Issuer | Description | 003122514J | 05 | GA | MEDICAID | 003122514K | 05 | GA | MEDICAID | 003122514O | 05 | GA | MEDICAID | 003122514A | 05 | GA | MEDICAID | 003122514Q | 05 | GA | MEDICAID | 003122514S | 05 | GA | MEDICAID | 07220802 | 05 | MS | MEDICAID | 003122514C | 05 | GA | MEDICAID | 003122514F | 05 | GA | MEDICAID | 003122514R | 05 | GA | MEDICAID | 003122514H | 05 | GA | MEDICAID | 003122514I | 05 | GA | MEDICAID | 003122514U | 05 | GA | MEDICAID | 003122514G | 05 | GA | MEDICAID | 003122514N | 05 | GA | MEDICAID | 003122514P | 05 | GA | MEDICAID | 003122514D | 05 | GA | MEDICAID | 003122514E | 05 | GA | MEDICAID | 003122514L | 05 | GA | MEDICAID | 003122514M | 05 | GA | MEDICAID | 003122514T | 05 | GA | MEDICAID | 1077445 | 05 | LA | MEDICAID |