Provider Demographics
NPI:1396890844
Name:THE KIMANI CLINIC, P.C.
Entity type:Organization
Organization Name:THE KIMANI CLINIC, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:ALEXANDRA
Authorized Official - Last Name:KIMANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-685-8485
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:404-685-8414
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:404-685-8414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP3307Medicare PIN