Organization
KENNESAW STATE UNIVERSITY HEALTH CLINIC
Active
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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