Individual
HAIKA GLORIA KISAMO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
811 KENNESAW AVE NW, MARIETTA, GA 30060-1002
(770) 422-2451
Mailing address
5323 WHITEHAVEN PARK LN SE, MABLETON, GA 30126-5957
(832) 818-0877
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
RN270976
GA
Other
Enumeration date
08/08/2023
Last updated
08/08/2023
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