Provider Demographics
NPI:1245430701
Name:KOZMA, KELLIE J (NP)
Entity Type:Individual
Prefix:MRS
First Name:KELLIE
Middle Name:J
Last Name:KOZMA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5800 WINDWARD PKWY
Mailing Address - Street 2:MS A211
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-8802
Mailing Address - Country:US
Mailing Address - Phone:678-319-5909
Mailing Address - Fax:
Practice Address - Street 1:5800 WINDWARD PKWY
Practice Address - Street 2:MS A211
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-8802
Practice Address - Country:US
Practice Address - Phone:678-319-5909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-23
Last Update Date:2015-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209005942363LF0000X
GARN 160612 NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily