Healthcare Provider Details

I. General information

NPI: 1245430701
Provider Name (Legal Business Name): KELLIE J. KOZMA N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2007
Last Update Date: 04/21/2025
Certification Date: 04/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1495 HICKORY FLAT HWY STE 100
CANTON GA
30115-4266
US

IV. Provider business mailing address

4300 N POINT PKWY STE 300
ALPHARETTA GA
30022-4102
US

V. Phone/Fax

Practice location:
  • Phone: 678-341-6360
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209005942
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN 160612 NP
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: