Healthcare Provider Details

I. General information

NPI: 1154053510
Provider Name (Legal Business Name): KAYS URGENT CARE CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2022
Last Update Date: 08/20/2024
Certification Date: 08/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4171 MARIETTA ST
POWDER SPRINGS GA
30127-2696
US

IV. Provider business mailing address

4171 MARIETTA ST
POWDER SPRINGS GA
30127-2696
US

V. Phone/Fax

Practice location:
  • Phone: 678-549-2323
  • Fax: 404-609-1268
Mailing address:
  • Phone: 678-549-2323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KAY YETUNDE JOHNSON
Title or Position: OWNER
Credential: NP
Phone: 678-549-2323