MEDICARE: KISHA NICOLE GARNER NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	RN198519	GA

General Provider Information

NPI Number	:	1386326981
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KISHA NICOLE GARNER NP

Provider Business Mailing Address
First Line	:	2730 PEACHTREE INDUSTRIAL BLVD STE 105
Second Line	:
City	:	DULUTH
State	:	GA
Zip	:	30097-8627
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2730 PEACHTREE INDUSTRIAL BLVD STE 105
Second Line	:
City	:	DULUTH
State	:	GA
Zip	:	30097-8627
Country	:	US
Telephone Number	:	404-786-3845
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/02/2023
Last Update Date	:	11/22/2023

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