Healthcare Provider Details

I. General information

NPI: 1760251235
Provider Name (Legal Business Name): KENISHA MAYS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/26/2023
Last Update Date: 12/26/2023
Certification Date: 12/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2217 ROSWELL RD STE 100
MARIETTA GA
30062-2957
US

IV. Provider business mailing address

2146 ROSWELL RD STE 108 PMB 510
MARIETTA GA
30062
US

V. Phone/Fax

Practice location:
  • Phone: 404-406-1389
  • Fax:
Mailing address:
  • Phone: 404-406-1389
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: