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General NPI Number Information
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NPI Number | 1396491254
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Entity Type | Organization
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Legal Business Name | KINGDOM CARDIOVASCULAR CARE AND WELLNESS CENTER, LLC
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Dates
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Enumeration Date | 03/01/2022
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Last Update Date | 11/02/2022
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Provider Practice Location Address
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Address Line | 6853 DOUGLAS BLVD STE C
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City | DOUGLASVILLE
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State | GA
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Zip | 30135-7179
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Country | US
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Telephone | 336-338-2019
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Fax |
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Provider Business Mailing Address
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Address Line | 3400 CHAPEL HILL RD STE 328
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City | DOUGLASVILLE
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State | GA
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Zip | 30135-1739
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Country | US
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Telephone | 678-785-5001
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KATHRYN AMANDA MCFARLAND
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Credential | MD
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Telephone | 336-338-2019
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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