Kimberly Diann Eddins

Primary specialty

Prosthetics Case ManagementTaxonomy code 1744P3200X

License

MT010080 Issued in GA

Practice address

4065 Flintridge Dr
Suite a
Stone Mountain, GA 30083-3122

Phone

(404) 274-5433

NPI assigned

Jul 25, 2015

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1437782400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1477008000000",
    "number": "1679958177",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4065 FLINTRIDGE DR",
            "city": "STONE MOUNTAIN",
            "state": "GA",
            "postal_code": "300833122",
            "telephone_number": "404-274-5433"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4065 FLINTRIDGE DR",
            "address_2": "SUITE A",
            "city": "STONE MOUNTAIN",
            "state": "GA",
            "postal_code": "300833122",
            "telephone_number": "404-274-5433"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDDINS",
        "first_name": "KIMBERLY",
        "middle_name": "DIANN",
        "name_prefix": "Ms.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-07-25",
        "last_updated": "2016-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "GA",
            "license": "MT010080",
            "primary": false
        },
        {
            "code": "1744P3200X",
            "taxonomy_group": "",
            "desc": "Specialist, Prosthetics Case Management",
            "state": "GA",
            "license": "MT010080",
            "primary": true
        },
        {
            "code": "1744P3200X",
            "taxonomy_group": "",
            "desc": "Specialist, Prosthetics Case Management",
            "state": "GA",
            "license": "CO077801",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Prosthetics Case Management in Stone Mountain, GA
• Providers in Stone Mountain, GA by specialty
• Prosthetics Case Management in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.