Active NPI
Agnes Kim, PT, DPT
- Physical Therapist
- Austell, GA
National Provider Identifier
1043823438
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT014923
- Practice address
- 1025 E West Connector Ste 406
Austell, GA 30106-8531 - Phone
- (770) 384-1001
- Fax
- (770) 384-0333
- NPI assigned
- Aug 26, 2020
- Last updated
- Aug 26, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT014923 | GA | Primary |
Addresses
Primary practice location
1025 E West Connector Ste 406
Austell, GA 30106-8531
Mailing address
1200 Corporate Dr Ste 400
Birmingham, AL 35242-5424
Phone (423) 238-7217
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT014923 | GA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1598400000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1598400000000",
"number": "1043823438",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1200 CORPORATE DR STE 400",
"city": "BIRMINGHAM",
"state": "AL",
"postal_code": "352425424",
"telephone_number": "423-238-7217",
"fax_number": "423-238-3473"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1025 E WEST CONNECTOR STE 406",
"city": "AUSTELL",
"state": "GA",
"postal_code": "301068531",
"telephone_number": "770-384-1001",
"fax_number": "770-384-0333"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "AGNES",
"credential": "PT, DPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-08-26",
"last_updated": "2020-08-26",
"certification_date": "2020-08-26",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "GA",
"license": "PT014923",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Austell, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 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.