Healthcare Provider Details

I. General information

NPI: 1083528632
Provider Name (Legal Business Name): MONICA DENISE KING
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3610 DOGWOOD PASS
STONECREST GA
30038-3297
US

IV. Provider business mailing address

3610 DOGWOOD PASS
STONECREST GA
30038-3297
US

V. Phone/Fax

Practice location:
  • Phone: 404-789-0503
  • Fax:
Mailing address:
  • Phone: 404-789-0503
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number8291251
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: