Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 43559 | CO |
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 43559 | CO |
NPI | 1669484903 |
---|---|
Provider Name | Dr. William Scott Kimmerly |
First Address | Atlanta, GA 30309-1476 |
Second Address | Atlanta, GA 30309-1476 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2006 |
Last Update Date | 22/05/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I38256 | (02) | CO |