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General NPI Number Information
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NPI Number | 1003244765
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Entity Type | Organization
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Legal Business Name | DR. KISSING OB & GYN
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Dates
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Enumeration Date | 10/16/2013
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Last Update Date | 10/16/2013
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Provider Practice Location Address
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Address Line | 5720 BUFORD HWY 102
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City | NORCROSS
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State | GA
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Zip | 30071-2577
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Country | US
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Telephone | 770-888-3102
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Fax | 770-212-2188
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Provider Business Mailing Address
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Address Line | 5720 BUFORD HWY 102
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City | NORCROSS
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State | GA
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Zip | 30071-2577
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Country | US
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Telephone | 770-888-3102
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Fax | 770-212-2188
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Authorized Official
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Title or Position | OWNER
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Name | DR. DOMINIK KISSING
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Credential | M.D.
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Telephone | 770-888-3102
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 64125
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License Number State | GA
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