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General NPI Number Information
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NPI Number | 1245430701
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Entity Type | Individual
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Provider Name | KELLIE J. KOZMA N.P.
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Gender | Female
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Dates
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Enumeration Date | 07/23/2007
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Last Update Date | 04/21/2025
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Provider Practice Location Address
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Address Line | 1495 HICKORY FLAT HWY STE 100
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City | CANTON
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State | GA
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Zip | 30115-4266
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Country | US
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Telephone | 678-341-6360
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Fax |
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Provider Business Mailing Address
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Address Line | 4300 N POINT PKWY STE 300
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City | ALPHARETTA
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State | GA
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Zip | 30022-4102
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 209005942
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN 160612 NP
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License Number State | GA
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