Basic Information
| Provider Information | |||||||||
| NPI: | 1770895757 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HORNSBY | ||||||||
| FirstName: | KIM | ||||||||
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| Credential: | MCD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 739 HUNTER CT | ||||||||
| Address2: | |||||||||
| City: | AUBURN | ||||||||
| State: | AL | ||||||||
| PostalCode: | 368325402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3345595466 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2424 DOUBLE CHURCHES RD | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 319092741 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7063246112 | ||||||||
| FaxNumber: | 7065968259 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2010 | ||||||||
| LastUpdateDate: | 05/25/2011 | ||||||||
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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 | 235Z00000X | PCET001544 | GA | N | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 235Z00000X | SLP007561 | GA | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.