Healthcare Provider Details

I. General information

NPI: 1861929283
Provider Name (Legal Business Name): JOSEPH K KINUTHIA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2017
Last Update Date: 07/21/2022
Certification Date: 10/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

677 CHURCH ST NE
MARIETTA GA
30060-1101
US

IV. Provider business mailing address

1514 VERNON RD
LAGRANGE GA
30240-4131
US

V. Phone/Fax

Practice location:
  • Phone: 770-793-5186
  • Fax:
Mailing address:
  • Phone: 706-812-2369
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number86473
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number86473
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: