Provider Demographics
NPI:1568054450
Name:KMA HEALTHCARE, LLC
Entity Type:Organization
Organization Name:KMA HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:GIANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOCHICCHIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-456-8704
Mailing Address - Street 1:110 SAMARITAN DR STE 205
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-2569
Mailing Address - Country:US
Mailing Address - Phone:678-989-6115
Mailing Address - Fax:
Practice Address - Street 1:110 SAMARITAN DR STE 205
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-2569
Practice Address - Country:US
Practice Address - Phone:678-456-8704
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-11
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory