Provider Demographics
NPI:1235683335
Name:ONO, KIM EMIKO (PHD)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:EMIKO
Last Name:ONO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4532 CLUB CIR NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30319-1054
Mailing Address - Country:US
Mailing Address - Phone:404-785-3874
Mailing Address - Fax:494-785-2851
Practice Address - Street 1:5461 MERIDIAN MARK RD STE 180
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-3112
Practice Address - Country:US
Practice Address - Phone:404-785-3974
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-08
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY004030282NC2000X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No282NC2000XHospitalsGeneral Acute Care HospitalChildren