Healthcare Provider Details

I. General information

NPI: 1669576203
Provider Name (Legal Business Name): THE KIOSKI ATLANTA GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 COURTLAND ST NE SUITE A302
ATLANTA GA
30303-1721
US

IV. Provider business mailing address

165 COURTLAND STREET SUITE A302
ATLANTA GA
30303
US

V. Phone/Fax

Practice location:
  • Phone: 404-543-2323
  • Fax:
Mailing address:
  • Phone: 404-543-2323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number StateFL

VIII. Authorized Official

Name: MR. RENE ROBERT
Title or Position: PRESIDENT
Credential:
Phone: 404-543-2323