Basic Information
| Provider Information | |||||||||
| NPI: | 1336482918 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SAVAGE | ||||||||
| FirstName: | KIMBERLY | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7402 DAVIDSON PKWY S | ||||||||
| Address2: | |||||||||
| City: | STOCKBRIDGE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 302814175 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7705070909 | ||||||||
| FaxNumber: | 7705071919 | ||||||||
| Practice Location | |||||||||
| Address1: | 7402 DAVIDSON PKWY S | ||||||||
| Address2: | |||||||||
| City: | STOCKBRIDGE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 302814175 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7705070909 | ||||||||
| FaxNumber: | 7705071919 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/01/2013 | ||||||||
| LastUpdateDate: | 02/01/2018 | ||||||||
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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 | 363LA2100X | RN139517 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
ID Information
| ID | Type | State | Issuer | Description | 003134199G | 05 | GA | MEDICAID | 003134199H | 05 | GA | MEDICAID |