Healthcare Provider Details

I. General information

NPI: 1588943070
Provider Name (Legal Business Name): GKM HEALTHCARE SOLUTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2011
Last Update Date: 02/28/2023
Certification Date: 02/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

760 OLD ROSWELL RD STE 211
ROSWELL GA
30076-8686
US

IV. Provider business mailing address

760 OLD ROSWELL RD STE 211
ROSWELL GA
30076-8686
US

V. Phone/Fax

Practice location:
  • Phone: 404-856-0505
  • Fax: 404-602-0081
Mailing address:
  • Phone: 404-856-0505
  • Fax: 404-602-0081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. KYM LEONARD
Title or Position: CLINICAL OPERATIONS MANAGER
Credential: FNP-BC
Phone: 404-856-0505