1184094625 NPI number — MRS. KIMMARIE NICOLA ROSS DNP

Table of content: MRS. KIMMARIE NICOLA ROSS DNP (NPI 1184094625)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184094625 NPI number — MRS. KIMMARIE NICOLA ROSS DNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROSS
Provider First Name:
KIMMARIE
Provider Middle Name:
NICOLA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
DNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ROSS
Provider Other First Name:
KIMMARIE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1184094625
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/21/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
80 GILMER ST. SE
Provider Second Line Business Mailing Address:
6TH FLOOR GI
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30303
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
646-431-7223
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
80 GILMER ST. SE
Provider Second Line Business Practice Location Address:
6TH FLOOR GI
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30303-3031
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-616-1000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/27/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  RN220682 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)