Healthcare Provider Details

I. General information

NPI: 1770101644
Provider Name (Legal Business Name): KASSIE GLEESON FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KASSIE HITE

II. Dates (important events)

Enumeration Date: 07/08/2020
Last Update Date: 11/03/2025
Certification Date: 11/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1825 HIGHWAY 34 E
NEWNAN GA
30265-6423
US

IV. Provider business mailing address

1680 HOLBROOK RD
NEWNAN GA
30263-6440
US

V. Phone/Fax

Practice location:
  • Phone: 770-502-2121
  • Fax:
Mailing address:
  • Phone: 770-314-3180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-NP259323
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: