Healthcare Provider Details

I. General information

NPI: 1245652726
Provider Name (Legal Business Name): THE KANE CLINIC'S
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2014
Last Update Date: 01/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 CLEARVIEW AVE SUITE 111
DORAVILLE GA
30340-2100
US

IV. Provider business mailing address

2000 CLEARVIEW AVE SUITE 111
DORAVILLE GA
30340-2100
US

V. Phone/Fax

Practice location:
  • Phone: 404-250-4447
  • Fax:
Mailing address:
  • Phone: 404-250-4447
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number State

VIII. Authorized Official

Name: MARCELA QUINTERO
Title or Position: BUSINESS MANAGER
Credential:
Phone: 404-250-4447