Healthcare Provider Details

I. General information

NPI: 1083203426
Provider Name (Legal Business Name): KIMBERLY ABUAJAH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2021
Last Update Date: 02/13/2026
Certification Date: 02/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2319 PRINCE AVE
ATHENS GA
30606-6030
US

IV. Provider business mailing address

100 WASHINGTON AVE S STE 100
MINNEAPOLIS MN
55401-2453
US

V. Phone/Fax

Practice location:
  • Phone: 999-999-9999
  • Fax: 855-600-5833
Mailing address:
  • Phone: 866-492-5336
  • Fax: 855-600-5833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberNP300337
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN300337
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: