Healthcare Provider Details

I. General information

NPI: 1184532665
Provider Name (Legal Business Name): JOYCE KINUTHIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 WINN WAY
DECATUR GA
30030-1715
US

IV. Provider business mailing address

4388 THORNGATE LN
ACWORTH GA
30101-6873
US

V. Phone/Fax

Practice location:
  • Phone: 404-294-0499
  • Fax:
Mailing address:
  • Phone: 678-500-6615
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN-NP276010
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: