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NPI Code Detail

MEDICARE: MRS. KIMLEY MAIENZA

MEDICARE: MRS. KIMLEY MAIENZA
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
11041C0700XClinical Social Worker000740GA

General Provider Information

NPI Number : 1760562706
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KIMLEY MAIENZA
Provider Business Mailing Address
First Line : 1080 RIVER PLANTATION DR
Second Line :
City : WOODSTOCK
State : GA
Zip : 30188-2387
Country : US
Telephone Number : 678-494-0999
Fax Number :
Provider Business Practice Location Address
First Line : 1827 POWERS FERRY RD SE
Second Line : BLDG 24, SUITE 300
City : ATLANTA
State : GA
Zip : 30339-5621
Country : US
Telephone Number : 770-818-0070
Fax Number : 770-818-0068
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/16/2006
Last Update Date : 07/08/2007

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Directions to “ MRS. KIMLEY MAIENZA ” Practice Location

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