Healthcare Provider Details

I. General information

NPI: 1245696772
Provider Name (Legal Business Name): GUISEON KIM NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2016
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 PEACHTREE RD NE
BROOKHAVEN GA
30319-2729
US

IV. Provider business mailing address

4400 PEACHTREE RD NE
BROOKHAVEN GA
30319-2729
US

V. Phone/Fax

Practice location:
  • Phone: 404-814-9199
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberGAA-NP002954
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number905033
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP08551
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: