Healthcare Provider Details

I. General information

NPI: 1770801995
Provider Name (Legal Business Name): KIMBERLY A COVENEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2010
Last Update Date: 01/10/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 JOHNSON FY RD NE KAISER PERMANENTE AT NORTHSIDE HOSPITAL
ATLANTA GA
30342-1606
US

IV. Provider business mailing address

3495 PIEDMONT RD NE NINE PIEDMONT CENTER
ATLANTA GA
30305-1717
US

V. Phone/Fax

Practice location:
  • Phone: 404-851-8000
  • Fax: 314-996-7691
Mailing address:
  • Phone: 404-504-5678
  • Fax: 314-996-7691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number2014015773
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number076494
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: