Healthcare Provider Details

I. General information

NPI: 1770261042
Provider Name (Legal Business Name): SIERRA KING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2023
Last Update Date: 07/07/2023
Certification Date: 07/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4395 FULTON INDUSTRIAL BLVD SW STE D1262
ATLANTA GA
30336-1956
US

IV. Provider business mailing address

PO BOX 91571
EAST POINT GA
30364-1571
US

V. Phone/Fax

Practice location:
  • Phone: 404-485-6116
  • Fax:
Mailing address:
  • Phone: 470-485-6116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: