Healthcare Provider Details

I. General information

NPI: 1235321530
Provider Name (Legal Business Name): KIM VERLEIGH COOLEY NNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2007
Last Update Date: 08/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 PEACHTREE DUNWOODY RD NE
ATLANTA GA
30328-5382
US

IV. Provider business mailing address

14 KATRINA DR
POWDER SPRINGS GA
30127-6810
US

V. Phone/Fax

Practice location:
  • Phone: 404-252-9751
  • Fax:
Mailing address:
  • Phone: 770-489-9477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License NumberRN095692
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: