NPIMap

Organization Active NPI

Kennesaw State University Health Clinic

  • Adult Mental Health Clinic/Center
  • Kennesaw, GA
National Provider Identifier
1831426931
Registry record updated Nov 10, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X
License
RN057224 Issued in GA
Legal business name
KENNESAW STATE UNIVERSITY HEALTH CLINIC
Practice address
1000 Chastain Rd NW
House 52
Kennesaw, GA 30144-5588
Phone
(770) 423-6644
NPI assigned
Nov 10, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 10, 2009

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

Authorized official

Name
Anne Nichols, APRN
Title
Health Clinic Director
Phone
(770) 423-6644

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Mental Health Clinic/Center 261QM0850X RN057224 GA Primary
Student Health Clinic/Center 261QS1000X RN057224 GA

Addresses

Primary practice location

1000 Chastain Rd NW
House 52
Kennesaw, GA 30144-5588

Mailing address

1000 Chastain Rd NW
House 52
Kennesaw, GA 30144-5588
Phone (770) 423-6644

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1257811200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1257811200000",
    "number": "1831426931",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 CHASTAIN RD NW",
            "address_2": "HOUSE 52",
            "city": "KENNESAW",
            "state": "GA",
            "postal_code": "301445588",
            "telephone_number": "770-423-6644"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 CHASTAIN RD NW",
            "address_2": "HOUSE 52",
            "city": "KENNESAW",
            "state": "GA",
            "postal_code": "301445588",
            "telephone_number": "770-423-6644"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENNESAW STATE UNIVERSITY HEALTH CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-11-10",
        "last_updated": "2009-11-10",
        "status": "A",
        "authorized_official_last_name": "NICHOLS",
        "authorized_official_first_name": "ANNE",
        "authorized_official_title_or_position": "HEALTH CLINIC DIRECTOR",
        "authorized_official_telephone_number": "770-423-6644",
        "authorized_official_credential": "APRN"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "GA",
            "license": "RN057224",
            "primary": true
        },
        {
            "code": "261QS1000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Student Health",
            "state": "GA",
            "license": "RN057224",
            "primary": false
        }
    ],
    "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 10, 2009; 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.