Provider Demographics
NPI:1902591472
Name:NIMBA INTEGRATIVE PRACTICE LLC
Entity Type:Organization
Organization Name:NIMBA INTEGRATIVE PRACTICE LLC
Other - Org Name:NIMBA INTEGRATIVE PRACTICE LLC STONE MOUNTAIN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ASATA
Authorized Official - Middle Name:KAMARA
Authorized Official - Last Name:APRN
Authorized Official - Suffix:
Authorized Official - Credentials:ASATA KAMARA DNP
Authorized Official - Phone:470-918-9719
Mailing Address - Street 1:5300 MEMORIAL DR STE 101
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30083-3154
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5300 MEMORIAL DR STE 101
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30083-3154
Practice Address - Country:US
Practice Address - Phone:470-918-9719
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NONE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-04-10
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care