Healthcare Provider Details

I. General information

NPI: 1578256442
Provider Name (Legal Business Name): KLY ENTERPRISE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2023
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3470 MCCLURE BRIDGE RD UNIT 133
DULUTH GA
30096-1102
US

IV. Provider business mailing address

5533 SOUTHWYCK BLVD STE 101
TOLEDO OH
43614-1505
US

V. Phone/Fax

Practice location:
  • Phone: 567-315-9730
  • Fax:
Mailing address:
  • Phone: 567-315-9730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number StateNULL

VIII. Authorized Official

Name: MISS KEIONDRA L YOUNG
Title or Position: OWNER
Credential:
Phone: 567-315-9730