Healthcare Provider Details

I. General information

NPI: 1912418096
Provider Name (Legal Business Name): KANEESHA ALFORD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2017
Last Update Date: 10/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5420 RIVERDALE RD
ATLANTA GA
30349-6129
US

IV. Provider business mailing address

11085 LANDON WAY
HAMPTON GA
30228-4058
US

V. Phone/Fax

Practice location:
  • Phone: 678-670-7774
  • Fax:
Mailing address:
  • Phone: 678-670-7774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: