Healthcare Provider Details

I. General information

NPI: 1073956546
Provider Name (Legal Business Name): JANICE K, HOGUE KINAHAN, NP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2013
Last Update Date: 04/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7938 STRATFORD LN
ATLANTA GA
30350-4159
US

IV. Provider business mailing address

7938 STRATFORD LN
ATLANTA GA
30350-4159
US

V. Phone/Fax

Practice location:
  • Phone: 770-804-9479
  • Fax: 770-396-7942
Mailing address:
  • Phone: 770-804-9479
  • Fax: 770-396-7942

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberRN087295
License Number StateGA

VIII. Authorized Official

Name: JANICE K HOGUE KINAHAN
Title or Position: OWNER
Credential: NP
Phone: 770-804-9479