Provider Demographics
NPI:1821448432
Name:KNOWLEDGE DEVELOPMENT ASE' GROUP LLC
Entity Type:Organization
Organization Name:KNOWLEDGE DEVELOPMENT ASE' GROUP LLC
Other - Org Name:KDAG, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROFESSOR
Authorized Official - Prefix:
Authorized Official - First Name:KENYA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSS-BEATTY
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, NCRMA
Authorized Official - Phone:410-215-8055
Mailing Address - Street 1:584 AMAL DR SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30315-4827
Mailing Address - Country:US
Mailing Address - Phone:410-215-8055
Mailing Address - Fax:
Practice Address - Street 1:584 AMAL DR SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30315-4827
Practice Address - Country:US
Practice Address - Phone:410-215-8055
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-14
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA13176350390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty