Provider Demographics
NPI:1710964440
Name:DEAN, KENYATTA VICTORIA (DO)
Entity Type:Individual
Prefix:DR
First Name:KENYATTA
Middle Name:VICTORIA
Last Name:DEAN
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Gender:F
Credentials:DO
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Mailing Address - Street 1:3495 PIEDMONT RD NE
Mailing Address - Street 2:NINE PIEDMONT CENTER
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-1717
Mailing Address - Country:US
Mailing Address - Phone:404-364-7000
Mailing Address - Fax:404-364-4732
Practice Address - Street 1:3650 STEVE REYNOLDS BLVD
Practice Address - Street 2:DEPARTMENT OF INTERNAL MEDICINE TEAM A
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-4506
Practice Address - Country:US
Practice Address - Phone:770-931-6011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-23
Last Update Date:2022-01-13
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Provider Licenses
StateLicense IDTaxonomies
GA052265207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H26942Medicare UPIN