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General NPI Number Information
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NPI Number | 1235105032
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Entity Type | Individual
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Provider Name | DIANE GREEN KING ATC, RD, CSSD
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Gender | Female
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Dates
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Enumeration Date | 02/23/2006
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Last Update Date | 03/03/2014
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Provider Practice Location Address
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Address Line | 410 PEACHTREE PKWY SUITE 300
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City | CUMMING
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State | GA
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Zip | 30041-7066
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Country | US
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Telephone | 404-354-0008
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Fax |
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Provider Business Mailing Address
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Address Line | 328 RHODES HOUSE CT
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City | SUWANEE
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State | GA
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Zip | 30024-6472
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Country | US
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Telephone | 770-831-4743
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 111
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License Number State | GA
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