Organization
KENNESAW STATE UNIVERSITY HEALTH CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANNE NICHOLS APRN (HEALTH CLINIC DIRECTOR)
(770) 423-6644
Entity
Organization
Contact information
Practice address
1000 CHASTAIN RD NW, HOUSE 52, KENNESAW, GA 30144-5588
(770) 423-6644
Mailing address
1000 CHASTAIN RD NW, HOUSE 52, KENNESAW, GA 30144-5588
(770) 423-6644
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
RN057224
GA
261QS1000X
Student Health Clinic/Center
RN057224
GA
Other
Enumeration date
11/10/2009
Last updated
11/10/2009
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