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Kiesha Hazelray , CNA

Physician β€’ Decatur, GA

Deactivated NPI 1285114306 Deactivated in NPPES Female Practitioner
Practice location in NPPES

2624 Kelly Lake Rd
Decatur, GA 300326417

Phone: 4234329401

Location details and other listings
Medical Disclaimer

This profile restates public CMS/NPPES data; T-MedInfo gives no medical advice — consult a licensed professional, and call 911 for emergencies.

This NPI Is Deactivated in NPPES

NPPES lists this NPI as deactivated as of September 27, 2022; the reason is not published. The records below are historical. They do not show whether Kiesha Hazelray currently practices or holds a license; check the state medical board for current license status.

NPI Enumeration Date August 17, 2018
NPI Deactivation Date September 27, 2022
NPI Active Period 2018 – 2022

Practice Location & Contact Primary Location

Practice Address

2624 Kelly Lake Rd

Decatur, GA 300326417

Telephone 4234329401
Organization at the Same NPPES Address or Phone
Tk Home Karing Service Facility NPI 1346724143

Matched by practice address or phone in NPPES. A shared address or phone does not confirm that this clinician works there.

NPI first issued

2018

The year this clinician's National Provider Identifier (NPI) was issued. An NPI is a unique 10-digit ID that US health care providers use for billing.

What this does not show: NPI first issued

NPIs have been issued only since 2005, so this year is not necessarily when the clinician started practicing.

Source: CMS NPPES NPI Registry.

Compared with the same specialty in Decatur and Georgia

Comparisons are not shown because NPPES lists this NPI as deactivated.

Sources: CMS Doctors and Clinicians, CMS NPPES NPI Registry. Specialty names follow the NUCC Health Care Provider Taxonomy.

Text: T-MedInfo Β· Report an error.

Specialties & License Numbers Reported to NPPES

Home Health Primary Specialty

NUCC Taxonomy Code: 251E00000X

A public agency or private organization, or a subdivision of such an agency or organization, that is primarily engaged in providing skilled nursing services and other therapeutic services, such as physical therapy, speech-language pathology services, or occupational therapy, medical social services, and home health aide services. It has policies established by a professional group associated with the agency or organization (including at least one physician and one registered nurse) to govern the services and provides for supervision of such services by a physician or a registered nurse; maintains clinical records on all patients; is licensed in accordance with State or local law or is approved by the State or local licensing agency as meeting the licensing standards, where applicable; and meets other conditions found by the Secretary of Health and Human Services to be necessary for health and safety.

Check License Status with the State Board License numbers are self-reported to NPPES; T-MedInfo does not confirm them against state records. Current status: Georgia Composite Medical Board.
Look Up on State Board Site

Career & Practice History Timeline

Changes recorded in monthly NPPES data files: addresses, names, credentials, specialties and NPI status

9 Historical Events
⚠️
NPI Profile Deactivated September 27, 2022

NPPES lists this NPI as deactivated as of September 27, 2022; the reason is not published.

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Updated Practice Location September 21, 2018

Registered at 209 CROLL CT APT 125, CHATTANOOGA, TN 374101017 (Tel: 4234329401)

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Medical Taxonomy / Specialty Registered (Primary Specialty) September 21, 2018

In Home Supportive Care

βœ…
NPI Profile Active August 17, 2018

NPI status registered as active in NPPES database

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Practice Location (Initial Record) August 17, 2018

Registered at 2624 KELLY LAKE RD, DECATUR, GA 300326417 (Tel: 4234329401)

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Business Mailing Address (Initial Record) August 17, 2018

Registered at PO BOX 80232, CHATTANOOGA, TN 374147232 (Tel: 4234329401)

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Provider Name / Credentials (Initial Record) August 17, 2018

Recorded as KIESHA HAZELRAY, CNA

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Medical Taxonomy / Specialty Registered (Primary Specialty) August 17, 2018

Home Health

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Initial NPI Registration & Enumeration August 17, 2018

First registered as active Individual Practitioner in NPPES Database.

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NPI Administrative Meta

NPI Number: 1285114306
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: August 17, 2018
Last Update: August 17, 2018
Deactivation Date: September 27, 2022

Mailing Address

Po Box 80232

Chattanooga, TN 374147232

Phone: 4234329401

About This Data NPPES fields (address, phone, specialty, license) are self-reported and may be outdated; Medicare fields follow the CMS dataset named in each section. Correct directly at NPPES.