Basic Information
| Provider Information | |||||||||
| NPI: | 1093009383 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CROSS | ||||||||
| FirstName: | KIMBERLY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 775 POPLAR RD | ||||||||
| Address2: | SUITE 210 | ||||||||
| City: | NEWNAN | ||||||||
| State: | GA | ||||||||
| PostalCode: | 302658300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7709912200 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 775 POPLAR RD | ||||||||
| Address2: | SUITE 210 | ||||||||
| City: | NEWNAN | ||||||||
| State: | GA | ||||||||
| PostalCode: | 302658300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7709912200 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2011 | ||||||||
| LastUpdateDate: | 04/29/2016 | ||||||||
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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 | 207V00000X | 075773 | GA | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.