MEDICARE: KINGS WOGHIREN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374U00000X	Home Health Aide	O33R0070	GA

General Provider Information

NPI Number	:	1316078652
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KINGS WOGHIREN

Provider Business Mailing Address
First Line	:	2470 WINDY HILL RD SE
Second Line	:	222
City	:	MARIETTA
State	:	GA
Zip	:	30067-8613
Country	:	US
Telephone Number	:	678-858-1843
Fax Number	:	678-574-0086

Provider Business Practice Location Address
First Line	:	2470 WINDY HILL RD SE
Second Line	:	222
City	:	MARIETTA
State	:	GA
Zip	:	30067-8613
Country	:	US
Telephone Number	:	678-858-1843
Fax Number	:	678-574-0086

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/08/2007
Last Update Date	:	07/09/2007

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Directions to “ KINGS WOGHIREN ” Practice Location

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