Healthcare Provider Details

I. General information

NPI: 1598476491
Provider Name (Legal Business Name): KIARA NICOLE POLONEY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIARA NICOLE MILANA NP

II. Dates (important events)

Enumeration Date: 12/12/2022
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3625 BRASELTON HWY
DACULA GA
30019-1014
US

IV. Provider business mailing address

3625 BRASELTON HWY
DACULA GA
30019-1014
US

V. Phone/Fax

Practice location:
  • Phone: 678-977-1694
  • Fax:
Mailing address:
  • Phone: 678-977-1694
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN216034
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704375490
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: