Healthcare Provider Details

I. General information

NPI: 1366194706
Provider Name (Legal Business Name): KIANA DESIREE HINES PHD, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2022
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 ROCK SPRINGS CIR NE APT 3-1523
ATLANTA GA
30306-2229
US

IV. Provider business mailing address

2897 N DRUID HILLS RD NE
ATLANTA GA
30329-3924
US

V. Phone/Fax

Practice location:
  • Phone: 678-517-9255
  • Fax:
Mailing address:
  • Phone: 678-517-9255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP011632
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: