Basic Information
| Provider Information | |||||||||
| NPI: | 1659519536 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CROM | ||||||||
| FirstName: | KIMBERLY | ||||||||
| MiddleName: | WILLIAMS | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | WHNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 83 UPPER RIVERDALE ROAD | ||||||||
| Address2: | SUITE 135 | ||||||||
| City: | RIVERDALE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30274 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7709910778 | ||||||||
| FaxNumber: | 7702104430 | ||||||||
| Practice Location | |||||||||
| Address1: | 83 UPPER RIVERDALE ROAD | ||||||||
| Address2: | SUITE 135 | ||||||||
| City: | RIVERDALE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30274 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7709910778 | ||||||||
| FaxNumber: | 7702104430 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/30/2009 | ||||||||
| LastUpdateDate: | 01/30/2009 | ||||||||
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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 | 363LW0102X | RN119083 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health |
No ID Information.