Healthcare Provider Details

I. General information

NPI: 1366978470
Provider Name (Legal Business Name): KINSLEY COWART MILLARD PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KINSLEY MARIE COWART PA

II. Dates (important events)

Enumeration Date: 05/10/2017
Last Update Date: 03/10/2022
Certification Date: 03/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 COLLIER RD NW STE 6015
ATLANTA GA
30309-1750
US

IV. Provider business mailing address

PO BOX 102321
ATLANTA GA
30368-2321
US

V. Phone/Fax

Practice location:
  • Phone: 404-351-5959
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number8361
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: