Provider Demographics
NPI:1063575272
Name:KIMANI, GRACE ALEXANDRA (MD)
Entity type:Individual
Prefix:DR
First Name:GRACE
Middle Name:ALEXANDRA
Last Name:KIMANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 54538
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-0538
Mailing Address - Country:US
Mailing Address - Phone:404-685-8485
Mailing Address - Fax:
Practice Address - Street 1:450 14TH ST NW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318-7963
Practice Address - Country:US
Practice Address - Phone:404-685-8485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA43074207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G83099Medicare UPIN