Healthcare Provider Details

I. General information

NPI: 1114166329
Provider Name (Legal Business Name): K & K HEALTHCARE SYSTEM, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2009
Last Update Date: 02/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 ELEANOR CT
STOCKBRIDGE GA
30281-9123
US

IV. Provider business mailing address

201 ELEANOR CT
STOCKBRIDGE GA
30281-9123
US

V. Phone/Fax

Practice location:
  • Phone: 678-289-4254
  • Fax: 678-289-4254
Mailing address:
  • Phone: 678-289-4254
  • Fax: 678-289-4254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number075R0014
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number075R0014
License Number StateGA

VIII. Authorized Official

Name: MS. OMOLAYO CATHERINE AKINBOTE
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 678-289-4254