Healthcare Provider Details

I. General information

NPI: 1467045815
Provider Name (Legal Business Name): KRYSTAL DAWKINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2021
Last Update Date: 10/30/2025
Certification Date: 10/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3495 PIEDMONT RD NE BUILDING 11, STE 121
ATLANTA GA
30305-1763
US

IV. Provider business mailing address

3495 PIEDMONT RD NE BUILDING 11, STE 121
ATLANTA GA
30305-1763
US

V. Phone/Fax

Practice location:
  • Phone: 212-696-1550
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number404188
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number802495
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: