Healthcare Provider Details

I. General information

NPI: 1386021665
Provider Name (Legal Business Name): KELLY KUCHTA N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2015
Last Update Date: 05/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

531 ASBURY CIR SUITE N340
ATLANTA GA
30322-1006
US

IV. Provider business mailing address

2152 HAVENWOOD TRL NE
BROOKHAVEN GA
30319-4018
US

V. Phone/Fax

Practice location:
  • Phone: 404-778-5975
  • Fax: 404-778-2630
Mailing address:
  • Phone: 770-851-1419
  • Fax: 404-686-4661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN198383
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: