Active NPI
Kimberly Herrin Cole, D.M.D.
- Dentist
- Gracewood, GA
National Provider Identifier
1730349705
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 10897
- Practice address
- 100 Myrtle Blvd
Gracewood, GA 30812 - Phone
- (706) 790-2144
- Fax
- (706) 790-2326
- NPI assigned
- Jun 13, 2008
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Dentist | 122300000X | 10897 | GA | Primary |
Addresses
Primary practice location
100 Myrtle Blvd
Gracewood, GA 30812
Mailing address
3621 Rivercrest Rd
Augusta, GA 30907-9400
Phone (706) 855-5993
Other names 1
- Kimberly Dawn Willingham
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 010897 | GA | MD | Internal Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1213315200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1673568000000",
"number": "1730349705",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3621 RIVERCREST RD",
"city": "AUGUSTA",
"state": "GA",
"postal_code": "309079400",
"telephone_number": "706-855-5993"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 MYRTLE BLVD",
"city": "GRACEWOOD",
"state": "GA",
"postal_code": "30812",
"telephone_number": "706-790-2144",
"fax_number": "706-790-2326"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COLE",
"first_name": "KIMBERLY",
"middle_name": "HERRIN",
"name_prefix": "Dr.",
"credential": "D.M.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-06-13",
"last_updated": "2023-01-13",
"certification_date": "2023-01-11",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "GA",
"license": "10897",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "KIMBERLY",
"last_name": "WILLINGHAM",
"middle_name": "DAWN",
"credential": "DMD",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Gracewood, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.