Provider Demographics
NPI:1871281121
Name:KERI HEART INC
Entity type:Organization
Organization Name:KERI HEART INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:LMSW
Authorized Official - Prefix:MISS
Authorized Official - First Name:LAQUANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:313-749-9118
Mailing Address - Street 1:3915 HIGH DOVE WAY SW
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30082-3562
Mailing Address - Country:US
Mailing Address - Phone:248-843-5470
Mailing Address - Fax:313-749-9118
Practice Address - Street 1:8735 DUNWOODY PL
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30350-2995
Practice Address - Country:US
Practice Address - Phone:248-843-5470
Practice Address - Fax:313-800-0149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-25
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty