Individual
MR. KIM DERRELL HENRY-BOXLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1779 RIDGEWOOD DR NE, ATLANTA, GA 30307-1165
(404) 664-2989
Mailing address
1779 RIDGEWOOD DR NE, ATLANTA, GA 30307-1165
(404) 664-2989
Taxonomy
Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
Primary
0028832917
GA
Other
Enumeration date
04/28/2023
Last updated
04/28/2023
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