Fagan, Kiley Katherine
Fagan, Kiley Katherine is an individual health care provider with primary practice located at 775 Aronson Lake Ct , Roswell GA 30075-7172. She recently has only one registered license in Allopathic & Osteopathic Physicians / Dermatology, which is considered as her primary health care specialty. Fagan, Kiley Katherine can be contacted via phone (770) 296-3795.Contact Information
Primary practice address
775 Aronson Lake Ct
Roswell GA 30075-7172
Phone: (770) 296-3795
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Dermatology | 207N00000X | 10808 | Georgia |
Profile Details
| NPI number | 1003479254 |
|---|---|
| LBN Legal business name | Fagan, Kiley Katherine |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Apr 15th, 2019 |
| Last updated | Apr 15th, 2019 - about 7 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1003479254 | NPPES |
| Georgia | MEDICAID | 10808 |
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