Healthcare Provider Details

I. General information

NPI: 1386154292
Provider Name (Legal Business Name): KINI SPADY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2017
Last Update Date: 10/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5050 WARM SPRINGS RD BLDG 3
COLUMBUS GA
31909-6953
US

IV. Provider business mailing address

2205 4TH ST NW
WASHINGTON DC
20059-1003
US

V. Phone/Fax

Practice location:
  • Phone: 706-221-1114
  • Fax: 706-221-1102
Mailing address:
  • Phone: 202-870-7985
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: