Healthcare Provider Details

I. General information

NPI: 1790602480
Provider Name (Legal Business Name): KCP ENTERPRISES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 SANDY SPRINGS PL
SANDY SPRINGS GA
30328-3812
US

IV. Provider business mailing address

1568 SOUTHLAKE PKWY
MORROW GA
30260-4153
US

V. Phone/Fax

Practice location:
  • Phone: 770-961-6222
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: EMMA C CULL
Title or Position: COO
Credential:
Phone: 678-469-5011