Healthcare Provider Details

I. General information

NPI: 1063359016
Provider Name (Legal Business Name): KAIROVIA MENTAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4519 WOODRUFF RD
COLUMBUS GA
31904-6011
US

IV. Provider business mailing address

4519 WOODRUFF RD STE 4
COLUMBUS GA
31904-6096
US

V. Phone/Fax

Practice location:
  • Phone: 706-250-0530
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: SHANAKAY OSBOURNE
Title or Position: OWNER
Credential:
Phone: 706-250-0530