Organization
DIVINITY INTERNAL MEDICINE & ASSOCIATES INC.
Active
Organization
DIVINITY INTERNAL MEDICINE & ASSOCIATES INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KYWAIN REID (PRESIDENT)
(678) 724-0862
Entity
Organization
Contact information
Practice address
494 BOULEVARD SE, ATLANTA, GA 30312-3426
(404) 607-1002
Mailing address
4426 HUGH HOWELL RD STE B160, TUCKER, GA 30084-4918
(678) 724-0862
Taxonomy
Speciality
Code
Description
License number
State
305S00000X
Point of Service
Primary
154999
GA
Other
Enumeration date
06/06/2012
Last updated
06/06/2012
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