Healthcare Provider Details

I. General information

NPI: 1568617546
Provider Name (Legal Business Name): KING DAVID COMMUNITY CENTER OF ATLANTA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2008
Last Update Date: 08/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5054 SINGLETON RD
NORCROSS GA
30093-2503
US

IV. Provider business mailing address

5054 SINGLETON RD
NORCROSS GA
30093-2503
US

V. Phone/Fax

Practice location:
  • Phone: 770-931-8591
  • Fax: 770-931-8609
Mailing address:
  • Phone: 770-931-8591
  • Fax: 770-931-8609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number067-R-0586
License Number StateGA

VIII. Authorized Official

Name: MS. KHANO ARANBAYEVA
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 770-931-8591