Provider Demographics
NPI:1801671912
Name:NANTAMBU, KAHLFANI SHOMARI
Entity type:Individual
Prefix:MR
First Name:KAHLFANI
Middle Name:SHOMARI
Last Name:NANTAMBU
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:KEVIN
Other - Middle Name:GEORGE
Other - Last Name:RIGGINS
Other - Suffix:SR
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1200 NEWNAN CROSSING BLVD E APT 905
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-1591
Mailing Address - Country:US
Mailing Address - Phone:678-698-6587
Mailing Address - Fax:
Practice Address - Street 1:33200 SCHOOLCRAFT RD STE 206
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48150
Practice Address - Country:US
Practice Address - Phone:866-698-7349
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-28
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI374U00000X, 376K00000X, 372500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider
No374U00000XNursing Service Related ProvidersHome Health Aide
No376K00000XNursing Service Related ProvidersNurse's Aide