Individual provider Active NPI

Avery Suzanne Kemp, AGACNP-BC

  • Nurse Practitioner
  • Atlanta, GA
National Provider Identifier
1902504582
Registry record updated Apr 4, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
RN277577 Issued in GA
Practice address
960 Johnson Ferry Rd Ste 500
Atlanta, GA 30342-1630
Phone
(404) 257-0006
Fax
(404) 851-1316
NPI assigned
Feb 22, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 4, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X RN277577 GA
Nurse Practitioner 363L00000X RN277577 GA Primary

Addresses

Primary practice location

960 Johnson Ferry Rd Ste 500
Atlanta, GA 30342-1630

Mailing address

960 Johnson Ferry Rd Ste 500
Atlanta, GA 30342-1630
Phone (404) 257-0006

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230501002466 GA Practitioner - Nurse Practitioner 5597120311 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Northside Surgical Professional Services LLCGroup PAC ID 8628253424, 367 clinicians

Practice addresses (Care Compare)

960 Johnson Ferry Rd
Suite 500
Atlanta, GA 30342-1630
Phone (404) 257-0006

980 Johnson Fy Rd NE
Suite 800
Atlanta, GA 30342-1608
Phone (404) 252-9063

Hospital & facility affiliations

  • Northside Hospital Hospital, Atlanta, GA, CCN 110161
  • Northside Hospital Forsyth Hospital, Cumming, GA, CCN 110005
  • Northside Hospital Cherokee Hospital, Canton, GA, CCN 110008

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
RN277577GAMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Northside Primary Care Professional Services, LLC CurrentSince Apr 1, 2023 Accepting new patients
Northside Primary Care Professional Services,LLC CurrentSince Apr 1, 2023 Accepting new patients
Northside Surgical Professional Services LLC CurrentSince Jan 14, 2025 Accepting new patients

Locations

1000 Johnson Ferry Rd
Sandy Springs, GA 30342
Phone (404) 851-8737

980 Johnson Fy Rd NE
Ste 800
Sandy Springs, GA 30342
Phone (404) 851-9909

960 Johnson Fy Rd NE
Ste 500
Sandy Springs, GA 30342
Phone (404) 257-0006

1000 Johnson Fy Rd NE
Sandy Springs, GA 30342
Phone (404) 851-1000

3350 Paddocks Pkwy
Suwanee, GA 30024
Phone (678) 474-9633

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1677024000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1680566400000",
    "number": "1902504582",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "960 JOHNSON FERRY RD STE 500",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303421630",
            "telephone_number": "404-257-0006",
            "fax_number": "404-851-1316"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "960 JOHNSON FERRY RD STE 500",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303421630",
            "telephone_number": "404-257-0006",
            "fax_number": "404-851-1316"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KEMP",
        "first_name": "AVERY",
        "middle_name": "SUZANNE",
        "credential": "AGACNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-02-22",
        "last_updated": "2023-04-04",
        "certification_date": "2023-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "GA",
            "license": "RN277577",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "GA",
            "license": "RN277577",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

Verify at the official NPI Registry.