Provider Demographics
NPI:1679220065
Name:KISER, DARNELL
Entity Type:Individual
Prefix:MR
First Name:DARNELL
Middle Name:
Last Name:KISER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5715 BUFORD HWY NE STE 105
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30340-1229
Mailing Address - Country:US
Mailing Address - Phone:470-579-0458
Mailing Address - Fax:
Practice Address - Street 1:5715 BUFORD HWY NE STE 105
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30340-1229
Practice Address - Country:US
Practice Address - Phone:470-579-0458
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-04
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide