Healthcare Provider Details

I. General information

NPI: 1679485205
Provider Name (Legal Business Name): KIYANNA HAIRSTON
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2468 WINDY HILL RD SE STE 400
MARIETTA GA
30067-8631
US

IV. Provider business mailing address

1001 BURNT HICKORY RD NW APT 427
MARIETTA GA
30064-1371
US

V. Phone/Fax

Practice location:
  • Phone: 678-829-5507
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIR066633
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: