Healthcare Provider Details

I. General information

NPI: 1730959297
Provider Name (Legal Business Name): KIMBERLY KAJA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2024
Last Update Date: 01/05/2024
Certification Date: 01/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

975 JOHNSON FY RD NE STE 100
ATLANTA GA
30342-1618
US

IV. Provider business mailing address

975 JOHNSON FY RD NE STE 100
ATLANTA GA
30342-1618
US

V. Phone/Fax

Practice location:
  • Phone: 404-256-1311
  • Fax: 404-256-5487
Mailing address:
  • Phone: 404-256-1311
  • Fax: 404-256-5487

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0121X
TaxonomyPlastic Surgery Registered Nurse
License NumberRN225658
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: