Healthcare Provider Details

I. General information

NPI: 1104741024
Provider Name (Legal Business Name): KIPP METRO ATLANTA COLLABORATIVE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 WHITE ST SW STE C
ATLANTA GA
30310-2627
US

IV. Provider business mailing address

1050 WHITE ST SW STE C
ATLANTA GA
30310-2627
US

V. Phone/Fax

Practice location:
  • Phone: 770-630-0479
  • Fax:
Mailing address:
  • Phone: 770-630-0479
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State

VIII. Authorized Official

Name: EVELYN FORBES
Title or Position: DIRECTOR OF HEALTH AND SAFETY
Credential: RN
Phone: 770-630-0479