Healthcare Provider Details

I. General information

NPI: 1962324459
Provider Name (Legal Business Name): KLEAN PLATE COMMUNITY OUTREACH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4983 JONESBORO RD
FOREST PARK GA
30297-3551
US

IV. Provider business mailing address

4983 JONESBORO RD
FOREST PARK GA
30297-3551
US

V. Phone/Fax

Practice location:
  • Phone: 678-281-5443
  • Fax:
Mailing address:
  • Phone: 678-281-5443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name: KATRICE SIMMONS
Title or Position: FOUNDER
Credential:
Phone: 678-281-5443