Divinity Internal Medicine & Associates Inc.

Primary specialty

Point of ServiceTaxonomy code 305S00000X

License

154999 Issued in GA

Legal business name

DIVINITY INTERNAL MEDICINE & ASSOCIATES INC.

Practice address

494 Boulevard SE
Atlanta, GA 30312-3426

Phone

(404) 607-1002

NPI assigned

Jun 6, 2012

Organization subpart

No

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

Authorized official

Name

Mr. Kywain Reid

Title

President

Phone

(678) 724-0862

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1338940800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1338940800000",
    "number": "1902167935",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4426 HUGH HOWELL RD STE B160",
            "city": "TUCKER",
            "state": "GA",
            "postal_code": "300844918",
            "telephone_number": "678-724-0862"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "494 BOULEVARD SE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303123426",
            "telephone_number": "404-607-1002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIVINITY INTERNAL MEDICINE & ASSOCIATES INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-06",
        "last_updated": "2012-06-06",
        "status": "A",
        "authorized_official_last_name": "REID",
        "authorized_official_first_name": "KYWAIN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "678-724-0862",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "305S00000X",
            "taxonomy_group": "",
            "desc": "Point of Service",
            "state": "GA",
            "license": "154999",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Divine Dermatology & Aesthetics LLC
• Divine Inclination Psychotherapy and Consulting, LLC
• Divine Intervention Behavioral Solutions LLC
• Divine Path Transit LLC
• Divine Therapy LLC
• Kaitlin Divinnie, AGPCNP
• Stephanie Dix
• Sumeet Dixit, MD
• Meshai Dixon-Olivares, LMFT
• Allison Grace Dixon, PA

• Point of Service in Atlanta, GA
• Providers in Atlanta, GA by specialty
• Point of Service in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2012; 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.