Healthcare Provider Details

I. General information

NPI: 1649206905
Provider Name (Legal Business Name): KATHLEEN ANN HALVEY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 03/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 NORTHSIDE FORSYTH DR STE 170
CUMMING GA
30041-7668
US

IV. Provider business mailing address

5671 PEACHTREE DUNWOODY RD NE SUITE 110
ATLANTA GA
30342-5000
US

V. Phone/Fax

Practice location:
  • Phone: 770-292-4806
  • Fax: 770-292-4808
Mailing address:
  • Phone: 678-843-5801
  • Fax: 678-843-7746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberRN189107
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number209003126
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN189107
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: