Provider Demographics
NPI:1043052541
Name:KIMBROUGH, DIANA (PMHNP)
Entity type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:
Last Name:KIMBROUGH
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:
Other - Last Name:MILLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:863 FLAT SHOALS RD SE # 110
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30094-6633
Mailing Address - Country:US
Mailing Address - Phone:404-388-5265
Mailing Address - Fax:
Practice Address - Street 1:911 CHAMBERS DR NW
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30012-3401
Practice Address - Country:US
Practice Address - Phone:770-278-8171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-07
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA269558363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health