Organization Active NPI

Dr. Kissing OB & GYN

  • Specialist
  • Norcross, GA
National Provider Identifier
1003244765
Registry record updated Oct 16, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
64125 Issued in GA
Legal business name
DR. KISSING OB & GYN
Practice address
5720 Buford Hwy
102
Norcross, GA 30071-2577
Phone
(770) 888-3102
Fax
(770) 212-2188
NPI assigned
Oct 16, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 16, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Dominik Kissing, M.D.
Title
Owner
Phone
(770) 888-3102

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X 64125 GA Primary

Addresses

Primary practice location

5720 Buford Hwy
102
Norcross, GA 30071-2577

Mailing address

5720 Buford Hwy
102
Norcross, GA 30071-2577
Phone (770) 888-3102

Other identifiers 1

IdentifierTypeStateIssuer
003112332DMedicaidGA

National Provider Directory

National Provider Directory
Tax ID family
Dr Kissing OB GYN3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1381881600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1381881600000",
    "number": "1003244765",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5720 BUFORD HWY",
            "address_2": "102",
            "city": "NORCROSS",
            "state": "GA",
            "postal_code": "300712577",
            "telephone_number": "770-888-3102",
            "fax_number": "770-212-2188"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5720 BUFORD HWY",
            "address_2": "102",
            "city": "NORCROSS",
            "state": "GA",
            "postal_code": "300712577",
            "telephone_number": "770-888-3102",
            "fax_number": "770-212-2188"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR. KISSING OB & GYN",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-16",
        "last_updated": "2013-10-16",
        "status": "A",
        "authorized_official_last_name": "KISSING",
        "authorized_official_first_name": "DOMINIK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "770-888-3102",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "GA",
            "license": "64125",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003112332D",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Norcross, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.