Healthcare Provider Details

I. General information

NPI: 1871282335
Provider Name (Legal Business Name): KIRAN KURAISHY FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIRAN WASIF

II. Dates (important events)

Enumeration Date: 05/02/2023
Last Update Date: 09/06/2024
Certification Date: 09/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3790 PLEASANT HILL RD STE 170
DULUTH GA
30096-5145
US

IV. Provider business mailing address

4300 N POINT PKWY STE 300
ALPHARETTA GA
30022-4102
US

V. Phone/Fax

Practice location:
  • Phone: 770-360-1020
  • Fax: 770-609-3054
Mailing address:
  • Phone: 770-442-1911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN286601
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: