MEDICARE: KYMBERLY ELROD RIZOTI 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	363L00000X	Nurse Practitioner	RN286165	GA

General Provider Information

NPI Number	:	1740066786
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYMBERLY ELROD RIZOTI NP

Provider Business Mailing Address
First Line	:	277 ARBOR HILLS RD S
Second Line	:
City	:	TALKING ROCK
State	:	GA
Zip	:	30175-4191
Country	:	US
Telephone Number	:	678-602-3554
Fax Number	:

Provider Business Practice Location Address
First Line	:	460 NORTHSIDE CHEROKEE BLVD STE 410
Second Line	:
City	:	CANTON
State	:	GA
Zip	:	30115-8023
Country	:	US
Telephone Number	:	678-786-7430
Fax Number	:	678-786-7431

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

Provider Enumeration Date	:	09/06/2023
Last Update Date	:	09/06/2023

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