Active NPI
Sophia Kim
- Pediatric Nurse Practitioner
- Montgomery, AL
National Provider Identifier
1851031249
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Nurse Practitioner
- License
- GAA-NP002128
- Practice address
- 2895 Zelda Rd
Montgomery, AL 36106-2697 - Phone
- (224) 715-1032
- NPI assigned
- Apr 1, 2022
- 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 |
|---|---|---|---|---|
| Pediatric Nurse Practitioner | 363LP0200X | GAA-NP002128 | GA | Primary |
Addresses
Primary practice location
2895 Zelda Rd
Montgomery, AL 36106-2697
Mailing address
3625 Braselton Hwy Ste 202
Dacula, GA 30019-4695
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 |
|---|---|---|---|
| GAA-NP002128 | GA | MD | Pediatric Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1648771200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1738368000000",
"number": "1851031249",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3625 BRASELTON HWY STE 202",
"city": "DACULA",
"state": "GA",
"postal_code": "300194695"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2895 ZELDA RD",
"city": "MONTGOMERY",
"state": "AL",
"postal_code": "361062697",
"telephone_number": "224-715-1032"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "SOPHIA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-04-01",
"last_updated": "2025-02-01",
"certification_date": "2025-02-01",
"status": "A"
},
"taxonomies": [
{
"code": "363LP0200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Pediatrics",
"state": "GA",
"license": "GAA-NP002128",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Montgomery, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.