Kimes, Heavenly
Kimes, Heavenly is an sole proprietor health care provider with primary practice located at 3240 Glencree Road , Conyers GA 30012-1167. She recently has only one registered license in Dental Providers / Dentist, which is considered as her primary health care specialty. Kimes, Heavenly can be contacted via phone (404) 713-4982.Contact Information
Primary practice address
3240 Glencree Road
Conyers GA 30012-1167
Phone: (404) 713-4982
Fax: (678) 413-2491
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / Dentist | 122300000X | DN012304 | Georgia |
Profile Details
| NPI number | 1114074192 |
|---|---|
| LBN Legal business name | Kimes, Heavenly |
| Credentials | |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jan 4th, 2007 |
| Last updated | May 15th, 2008 - about 18 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1114074192 | NPPES |
| Georgia | MEDICAID | 000898015B | |
| Georgia | MEDICAID | 000898015A | |
| Georgia | MEDICAID | 000898015C |
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