Healthcare Provider Details

I. General information

NPI: 1619743259
Provider Name (Legal Business Name): MOLLY JANE KRUE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2023
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

745 CHASTAIN RD NW STE 1060
KENNESAW GA
30144-3002
US

IV. Provider business mailing address

6641 CADENCE BLVD
SANDY SPRINGS GA
30328-2874
US

V. Phone/Fax

Practice location:
  • Phone: 470-450-4156
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberGAA-NP005568
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1-186838
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: