Healthcare Provider Details

I. General information

NPI: 1376292839
Provider Name (Legal Business Name): ROSALID KIMANI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2022
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 MEDICAL DR NE STE 350
CARTERSVILLE GA
30121-8005
US

IV. Provider business mailing address

1314 CONCORD RD SE
SMYRNA GA
30080-4361
US

V. Phone/Fax

Practice location:
  • Phone: 470-737-1606
  • Fax: 833-973-4256
Mailing address:
  • Phone: 770-438-1799
  • Fax: 770-825-9046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP61368059
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN255620
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: