MEDICARE: JOSEPH KIM APRN, FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	RN319919	GA

General Provider Information

NPI Number	:	1033898499
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH KIM APRN, FNP-C

Provider Business Mailing Address
First Line	:	259 PRIVET CIR
Second Line	:
City	:	SUWANEE
State	:	GA
Zip	:	30024-7447
Country	:	US
Telephone Number	:	505-331-6509
Fax Number	:

Provider Business Practice Location Address
First Line	:	2685 PEACHTREE PKWY
Second Line	:
City	:	SUWANEE
State	:	GA
Zip	:	30024-5646
Country	:	US
Telephone Number	:	770-771-5260
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2023
Last Update Date	:	07/13/2023

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