Active NPI
Marilyn Cecelia Kimble, PH.D.
- Clinical Psychologist
- Clarkston, GA
National Provider Identifier
1962412601
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 1456
- Practice address
- 1138 Melrose Dr
Clarkston, GA 30021-2837 - Phone
- (404) 508-2348
- NPI assigned
- Aug 8, 2006
- Last updated
- Jul 8, 2007
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 1456 | GA | Primary |
Addresses
Primary practice location
1138 Melrose Dr
Clarkston, GA 30021-2837
Mailing address
1138 Melrose Dr
Clarkston, GA 30021-2837
Phone (404) 508-2348
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 61-00158 | Other | GA | EVERCARE CHOICE PROVIDER |
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)
- Enrolled
- Credentials
- Doctor of Philosophy
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154995200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1962412601",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1138 MELROSE DR",
"city": "CLARKSTON",
"state": "GA",
"postal_code": "300212837",
"telephone_number": "404-508-2348"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1138 MELROSE DR",
"city": "CLARKSTON",
"state": "GA",
"postal_code": "300212837",
"telephone_number": "404-508-2348"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIMBLE",
"first_name": "MARILYN",
"middle_name": "CECELIA",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-08-08",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "GA",
"license": "1456",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "EVERCARE CHOICE PROVIDER",
"identifier": "61-00158",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Clarkston, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.