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General NPI Number Information
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NPI Number | 1821448432
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Entity Type | Organization
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Legal Business Name | KNOWLEDGE DEVELOPMENT ASE' GROUP LLC
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Dates
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Enumeration Date | 06/14/2016
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Last Update Date | 06/14/2016
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Provider Practice Location Address
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Address Line | 584 AMAL DR SW
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City | ATLANTA
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State | GA
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Zip | 30315-4827
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Country | US
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Telephone | 410-215-8055
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Fax |
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Provider Business Mailing Address
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Address Line | 584 AMAL DR SW
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City | ATLANTA
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State | GA
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Zip | 30315-4827
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Country | US
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Telephone | 410-215-8055
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Fax |
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Authorized Official
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Title or Position | PROFESSOR
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Name | KENYA ROSS-BEATTY
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Credential | M.B.A., N.C.R.M.A.
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Telephone | 410-215-8055
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 13176350
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License Number State | GA
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