Provider Demographics
NPI:1245664283
Name:KIMBROUGH, SANDRA D
Entity type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:D
Last Name:KIMBROUGH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3735 CALIFON DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31906-4601
Mailing Address - Country:US
Mailing Address - Phone:706-662-7196
Mailing Address - Fax:706-940-0310
Practice Address - Street 1:3735 CALIFON DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31906-4601
Practice Address - Country:US
Practice Address - Phone:706-662-7196
Practice Address - Fax:706-940-0310
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-27
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No376K00000XNursing Service Related ProvidersNurse's Aide
No171W00000XOther Service ProvidersContractor
No251B00000XAgenciesCase Management
No251E00000XAgenciesHome Health
No347C00000XTransportation ServicesPrivate Vehicle