Healthcare Provider Details

I. General information

NPI: 1295559656
Provider Name (Legal Business Name): KNU-HEALTH ATLANTA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2024
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2215 CHESHIRE BRIDGE RD NE STE C
ATLANTA GA
30324-4234
US

IV. Provider business mailing address

2215 CHESHIRE BRIDGE RD NE STE C
ATLANTA GA
30324-4234
US

V. Phone/Fax

Practice location:
  • Phone: 978-335-6077
  • Fax:
Mailing address:
  • Phone: 978-335-6077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DAWN DEPORTER
Title or Position: CHIEF OPERATING OFFICER
Credential: RPH
Phone: 978-335-6077