Provider Demographics
NPI:1154053510
Name:KAYS URGENT CARE CLINIC LLC
Entity type:Organization
Organization Name:KAYS URGENT CARE CLINIC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAY
Authorized Official - Middle Name:YETUNDE
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:678-549-2323
Mailing Address - Street 1:4171 MARIETTA ST
Mailing Address - Street 2:
Mailing Address - City:POWDER SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30127-2696
Mailing Address - Country:US
Mailing Address - Phone:678-549-2323
Mailing Address - Fax:
Practice Address - Street 1:4171 MARIETTA ST
Practice Address - Street 2:
Practice Address - City:POWDER SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30127-2696
Practice Address - Country:US
Practice Address - Phone:678-549-2323
Practice Address - Fax:404-609-1268
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-25
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No163WW0000XNursing Service ProvidersRegistered NurseWound CareGroup - Multi-Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1790167856Medicaid
0Other01