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General NPI Number Information
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NPI Number | 1720678246
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Entity Type | Organization
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Legal Business Name | ADVANCED PRACTICE TELEMEDICINE
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Dates
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Enumeration Date | 01/19/2021
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Last Update Date | 05/01/2025
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Provider Practice Location Address
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Address Line | 361 17TH ST NW UNIT 718
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City | ATLANTA
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State | GA
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Zip | 30363-1080
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Country | US
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Telephone | 478-443-0964
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Fax |
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Provider Business Mailing Address
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Address Line | 361 17TH ST NW UNIT 718
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City | ATLANTA
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State | GA
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Zip | 30363-1080
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Country | US
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Telephone | 478-443-0964
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Fax |
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Authorized Official
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Title or Position | BUSINESS OWNER
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Name | CHARLES E KITCHENS
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Credential | NP-C
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Telephone | 478-443-0964
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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