Healthcare Provider Details

I. General information

NPI: 1861234155
Provider Name (Legal Business Name): KIMBERLY ANNE IRWIN ATR-P
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2024
Last Update Date: 06/10/2024
Certification Date: 06/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2320 PERIMETER PARK DR
ATLANTA GA
30341-1317
US

IV. Provider business mailing address

1533 HIGH HAVEN CT NE
ATLANTA GA
30329-3203
US

V. Phone/Fax

Practice location:
  • Phone: 404-987-3230
  • Fax:
Mailing address:
  • Phone: 404-987-3230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number24-305
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: