Provider Demographics
NPI:1972374312
Name:COX, KELVIN B
Entity type:Individual
Prefix:
First Name:KELVIN
Middle Name:B
Last Name:COX
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7610 SUMMER BERRY LN
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30038-7159
Mailing Address - Country:US
Mailing Address - Phone:404-805-5662
Mailing Address - Fax:
Practice Address - Street 1:7610 SUMMER BERRY LN
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30038-7159
Practice Address - Country:US
Practice Address - Phone:404-805-5662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-15
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker