MEDICARE: KINGS HEALTHCARE SERVICES

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1841945565
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KINGS HEALTHCARE SERVICES

Provider Business Mailing Address
First Line	:	2158 CUMBERLAND PKWY SE APT 10202
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30339-4575
Country	:	US
Telephone Number	:	404-519-0230
Fax Number	:	404-748-9634

Provider Business Practice Location Address
First Line	:	2158 CUMBERLAND PKWY SE APT 10202
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30339-4575
Country	:	US
Telephone Number	:	404-519-0230
Fax Number	:	404-748-9634

Authorized Official
Title or Position	:	OWNER
Name	:	MS. RACHEL ANN KING
Credential	:
Telephone Number	:	404-519-0230

Provider Enumeration Date	:	02/22/2022
Last Update Date	:	02/23/2022

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Directions to “KINGS HEALTHCARE SERVICES ” Practice Location

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