Provider Demographics
NPI:1053395277
Name:FLORENCE, KIM CAMILLE (MD)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:CAMILLE
Last Name:FLORENCE
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 1:2525 SKYLAKE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31907-2845
Mailing Address - Country:US
Mailing Address - Phone:267-505-4993
Mailing Address - Fax:
Practice Address - Street 1:2000 10TH AVE
Practice Address - Street 2:SUITE 170
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-3700
Practice Address - Country:US
Practice Address - Phone:267-505-4993
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07847700207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0122785Medicaid
NJ0122785Medicaid
093511Medicare ID - Type Unspecified