Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0000X | Obstetrician | RN058394 | GA |
NPI | 1215969175 |
---|---|
Provider Name | Joyce King |
First Address | Stone Mountain, GA 30087 |
Second Address | Atlanta, GA 30308 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
S86396001 | (02) | GA |