MEDICARE: MS. KIM MCKINNEY MPA

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	171M00000X	Case Manager/Care Coordinator
2	174H00000X	Health Educator

General Provider Information

NPI Number	:	1811318835
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KIM MCKINNEY MPA

Provider Business Mailing Address
First Line	:	PO BOX 16563
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30321-0563
Country	:	US
Telephone Number	:	404-513-0272
Fax Number	:

Provider Business Practice Location Address
First Line	:	1104 SOUTH PARKWOOD DRIVE
Second Line	:
City	:	FOREST PARK
State	:	GA
Zip	:	30297
Country	:	US
Telephone Number	:	404-513-0272
Fax Number	:

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

Provider Enumeration Date	:	12/17/2013
Last Update Date	:	12/17/2013

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