Active NPI
Kimberly Chantelle Garcia
- Body Imaging Physician
- Lawrenceville, GA
National Provider Identifier
1619632346
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Body Imaging Physician
- License
- 328775
- Practice address
- 630 New Hope Rd.,Ste 111
Lawrenceville, GA 30045 - Phone
- (470) 234-6117
- Fax
- (678) 348-7481
- NPI assigned
- Nov 8, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Body Imaging Physician | 2085B0100X | 328775 | GA | Primary |
Addresses
Primary practice location
630 New Hope Rd.,Ste 111
Lawrenceville, GA 30045
Mailing address
630 New Hope Rd.,Ste 111
Lawrenceville, GA 30045
Phone (470) 234-6117
Other practice location 1
153 Silvertop Dr SE
Grayson, GA 30017
Other practice location 2
153 Silvertop Dr
Grayson, GA 30017-4195
Other practice location 3
153 Silvertop Dr
Grayson, GA 30017-4195
Phone (470) 234-6117
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | NA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 328775 | GA | MD | Body Imaging Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1636329600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1636329600000",
"number": "1619632346",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "630 NEW HOPE RD.,STE 111",
"city": "LAWRENCEVILLE",
"state": "GA",
"postal_code": "30045",
"telephone_number": "470-234-6117",
"fax_number": "678-348-7481"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "630 NEW HOPE RD.,STE 111",
"city": "LAWRENCEVILLE",
"state": "GA",
"postal_code": "30045",
"telephone_number": "470-234-6117",
"fax_number": "678-348-7481"
}
],
"practiceLocations": [
{
"address_1": "153 Silvertop Dr SE",
"address_purpose": "LOCATION",
"city": "Grayson",
"state": "GA",
"postal_code": "30017",
"country_code": "US",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "153 Silvertop Dr",
"address_purpose": "LOCATION",
"city": "Grayson",
"state": "GA",
"postal_code": "300174195",
"country_code": "US",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "153 Silvertop Dr",
"address_purpose": "LOCATION",
"city": "Grayson",
"state": "GA",
"postal_code": "300174195",
"country_code": "US",
"telephone_number": "470-234-6117",
"fax_number": "678-348-7481",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "GARCIA",
"first_name": "KIMBERLY",
"middle_name": "CHANTELLE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-11-08",
"last_updated": "2021-11-08",
"certification_date": "2021-10-19",
"status": "A"
},
"taxonomies": [
{
"code": "2085B0100X",
"taxonomy_group": "",
"desc": "Radiology, Body Imaging",
"state": "GA",
"license": "328775",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "NA",
"affiliation": "N",
"address_1": "630 New Hope Rd.,Ste 111",
"city": "Lawrenceville",
"state": "GA",
"country_code": "US",
"postal_code": "30045",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Lawrenceville, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.