Healthcare Provider Details

I. General information

NPI: 1073468286
Provider Name (Legal Business Name): KNU SCOPE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4043 BIG VALLEY TRL # A
STONE MOUNTAIN GA
30083-5711
US

IV. Provider business mailing address

4043 BIG VALLEY TRL # A
STONE MOUNTAIN GA
30083-5711
US

V. Phone/Fax

Practice location:
  • Phone: 770-899-2849
  • Fax:
Mailing address:
  • Phone: 770-899-2849
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name: KENYON T. LINDSEY
Title or Position: CEO
Credential: LPC
Phone: 770-899-2849