Provider Demographics
NPI:1295559656
Name:KNU-HEALTH ATLANTA, INC.
Entity type:Organization
Organization Name:KNU-HEALTH ATLANTA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:DEPORTER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:978-335-6077
Mailing Address - Street 1:2215 CHESHIRE BRIDGE RD NE STE C
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30324-4234
Mailing Address - Country:US
Mailing Address - Phone:978-335-6077
Mailing Address - Fax:
Practice Address - Street 1:2215 CHESHIRE BRIDGE RD NE STE C
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30324-4234
Practice Address - Country:US
Practice Address - Phone:978-335-6077
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-12
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy