Individual provider Active NPI

Minju Kim, APRN

  • Family Nurse Practitioner
  • Lawrenceville, GA
National Provider Identifier
1992073761
Registry record updated May 13, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
RN198757 Issued in GA
Practice address
595 Hurricane Shoals Rd NW Ste 100
Lawrenceville, GA 30046-8762
Phone
(404) 645-7150
NPI assigned
Dec 8, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 13, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X RN198757 GA Primary

Addresses

Primary practice location

595 Hurricane Shoals Rd NW Ste 100
Lawrenceville, GA 30046-8762

Mailing address

595 Hurricane Shoals Rd NW Ste 100
Lawrenceville, GA 30046-8762
Phone (404) 645-7150

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
I20120510000225 GA Practitioner - Nurse Practitioner 6608038542 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Gate City Medical College, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Georgia Nephrology, LLCGroup PAC ID 4082606496, 29 clinicians

Practice addresses (Care Compare)

595 Hurricane Shoals NWRD
Suite 202
Lawrenceville, GA 30046-8761
Phone (404) 645-7150

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
RN198757GAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Women'S Health Enterprise, Inc Family Current Accepting new patients
Georgia Nephrology, LLC CurrentSince Jun 1, 2021 Accepting new patients

Locations

634 McDonough Blvd SE
Atlanta, GA 30315
Phone (404) 635-1300

497 Winn Way
Ste A210
Decatur, GA 30030
Phone (404) 294-7033

595 Hurricane Shoals Rd NW
Ste 100
Lawrenceville, GA 30046
Phone (404) 645-7150

595 Hurricane Shoals Rd NW
Ste 202
Lawrenceville, GA 30046
Phone (404) 645-7150

Interoperability endpoints

  • Direct secure messaging: mkim32432@direct.acumenmd.com

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1323302400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620864000000",
    "number": "1992073761",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "595 HURRICANE SHOALS RD NW STE 100",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300468762",
            "telephone_number": "404-645-7150"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "595 HURRICANE SHOALS RD NW STE 100",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300468762",
            "telephone_number": "404-645-7150"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "MINJU",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-12-08",
        "last_updated": "2021-05-13",
        "certification_date": "2021-05-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN198757",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lawrenceville, GA

Sources for this page

Verify at the official NPI Registry.