Active NPI
Damali Aida Hepburn, PHARM.D.
- Pharmacist
- Kennesaw, GA
National Provider Identifier
1396213534
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 0202208696
- Practice address
- 2465 Kaley Walk NW
Kennesaw, GA 30152-3015 - Phone
- (770) 714-4784
- NPI assigned
- Nov 6, 2018
- Last updated
- Nov 6, 2018
- 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 |
|---|---|---|---|---|
| Pharmacist | 183500000X | 0202208696 | VA | Primary |
Addresses
Primary practice location
2465 Kaley Walk NW
Kennesaw, GA 30152-3015
Mailing address
2465 Kaley Walk NW
Kennesaw, GA 30152-2684
Phone (770) 714-4784
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)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0202208696 | VA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1541462400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1541462400000",
"number": "1396213534",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2465 KALEY WALK NW",
"city": "KENNESAW",
"state": "GA",
"postal_code": "301522684",
"telephone_number": "770-714-4784"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2465 KALEY WALK NW",
"city": "KENNESAW",
"state": "GA",
"postal_code": "301523015",
"telephone_number": "770-714-4784"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HEPBURN",
"first_name": "DAMALI",
"middle_name": "AIDA",
"credential": "PHARM.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-11-06",
"last_updated": "2018-11-06",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "VA",
"license": "0202208696",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kennesaw, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.