Healthcare Provider Details

I. General information

NPI: 1285287441
Provider Name (Legal Business Name): KEVONDRIA CAGER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2019
Last Update Date: 07/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3890 REDWINE RD SW STE 208
ATLANTA GA
30331-5583
US

IV. Provider business mailing address

4500 SATELLITE BLVD STE 2250
DULUTH GA
30096-5047
US

V. Phone/Fax

Practice location:
  • Phone: 800-381-2195
  • Fax: 888-381-0822
Mailing address:
  • Phone: 800-381-2195
  • Fax: 888-381-0822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT007393
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: