KJ Adult Care ,LLC

Primary specialty

Adult Day Care Clinic/CenterTaxonomy code 261QA0600X

Legal business name

KJ ADULT CARE ,LLC

Practice address

1002 W Solomon St
Griffin, GA 30223-2632

Phone

(678) 557-2613

Fax

(678) 572-4514

NPI assigned

Jun 11, 2020

Organization subpart

No

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

Authorized official

Name

Tracie Renee ChislomNPI 1801354774

Title

Owner

Phone

(678) 557-2613

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• KJ Adult Care, LLC Former legal business name

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Tracie Chislom

  • Adult Day Care Clinic/Center
  • Griffin, GA
  • NPI 1801354774
  NPD Authorized official

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

{
    "created_epoch": "1591833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1591833600000",
    "number": "1003431438",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1002 W SOLOMON ST",
            "city": "GRIFFIN",
            "state": "GA",
            "postal_code": "302232632",
            "telephone_number": "678-557-2613",
            "fax_number": "678-572-4514"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1002 W SOLOMON ST",
            "city": "GRIFFIN",
            "state": "GA",
            "postal_code": "302232632",
            "telephone_number": "678-557-2613",
            "fax_number": "678-572-4514"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KJ ADULT CARE ,LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-11",
        "last_updated": "2020-06-11",
        "certification_date": "2020-06-11",
        "status": "A",
        "authorized_official_last_name": "CHISLOM",
        "authorized_official_first_name": "TRACIE",
        "authorized_official_middle_name": "RENEE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "678-557-2613"
    },
    "taxonomies": [
        {
            "code": "261QA0600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Day Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1801354774",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "KJ Adult Care, LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Dalia Kinsey, REGISTERED DIETITIAN
• Kiona Dunn, LPC, LLC
• Kevin Mark Kirkland, DMD
• Karla Jean Kistner, M.S., CCC-A
• Gary Thomas Kittrell, PHD
• Alyssa Klinger
• Connie Lee (Becker) Klopfenstein, APRN, CS
• Taylor Kohn
• Chelsae Patricia Kopp, MD
• Nageshwar Reddy Kothur, MD

• Adult Day Care Clinic/Center in Griffin, GA
• Providers in Griffin, GA by specialty
• Adult Day Care Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2020; 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.