MEDICARE: JAMES KINGMAN M.S.

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	101YM0800X	Mental Health Counselor	APC004656	GA

General Provider Information

NPI Number	:	1770934523
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES KINGMAN M.S.

Provider Business Mailing Address
First Line	:	4410 KINGSFIELD CT
Second Line	:
City	:	DUNWOODY
State	:	GA
Zip	:	30338-6636
Country	:	US
Telephone Number	:	404-840-2111
Fax Number	:

Provider Business Practice Location Address
First Line	:	2801 BUFORD HWY NE STE 501
Second Line	:
City	:	BROOKHAVEN
State	:	GA
Zip	:	30329-2137
Country	:	US
Telephone Number	:	404-840-2111
Fax Number	:

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

Provider Enumeration Date	:	06/23/2016
Last Update Date	:	09/20/2024

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