Provider Demographics
NPI:1801348602
Name:KEMP, NICOLE DEGRAFFENREID
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:DEGRAFFENREID
Last Name:KEMP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:DEGRAFFENREID
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7135 FLETCHER DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON
Mailing Address - State:GA
Mailing Address - Zip Code:30187
Mailing Address - Country:US
Mailing Address - Phone:770-653-7609
Mailing Address - Fax:
Practice Address - Street 1:3480 GREENBRIAR PKWY
Practice Address - Street 2:SUITE 117
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331
Practice Address - Country:US
Practice Address - Phone:770-653-7609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-27
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management