Provider Demographics
NPI:1023071008
Name:WINZER, KIMBERLY J (MD)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:J
Last Name:WINZER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 961287
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30296-6903
Mailing Address - Country:US
Mailing Address - Phone:404-290-2327
Mailing Address - Fax:
Practice Address - Street 1:1422 CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344-6983
Practice Address - Country:US
Practice Address - Phone:404-766-3337
Practice Address - Fax:404-766-1464
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA033258208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00596461LMedicaid
GA00596461LMedicaid