Healthcare Provider Details

I. General information

NPI: 1952282295
Provider Name (Legal Business Name): KILA ACEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2025
Last Update Date: 09/12/2025
Certification Date: 09/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3214 BROOKSONG WAY
DACULA GA
30019-4507
US

IV. Provider business mailing address

2700 BRASELTON HWY STE 10-66
DACULA GA
30019-3262
US

V. Phone/Fax

Practice location:
  • Phone: 770-616-5017
  • Fax:
Mailing address:
  • Phone: 770-616-5017
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberALCA000869
License Number StateGA
# 5
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number
License Number StateGA
# 6
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number StateGA
# 7
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License NumberNCCAP50288814-24NT
License Number StateGA
# 8
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateGA
# 9
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: