Provider Demographics
NPI:1669576203
Name:THE KIOSKI ATLANTA GROUP INC
Entity type:Organization
Organization Name:THE KIOSKI ATLANTA GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RENE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-543-2323
Mailing Address - Street 1:165 COURTLAND STREET
Mailing Address - Street 2:SUITE A302
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30303
Mailing Address - Country:US
Mailing Address - Phone:404-543-2323
Mailing Address - Fax:
Practice Address - Street 1:165 COURTLAND ST NE
Practice Address - Street 2:SUITE A302
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303-1721
Practice Address - Country:US
Practice Address - Phone:404-543-2323
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty