=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447440094
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | K &K CONSULTING SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/30/2007
-----------------------------------------------------
Last Update Date | 07/30/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5701 MABLETON PKWY SW STE 4C
-----------------------------------------------------
City | MABLETON
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30126-3390
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-944-8208
-----------------------------------------------------
Fax | 770-944-8209
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 17627
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30316-0627
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-944-8208
-----------------------------------------------------
Fax | 770-944-8209
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | MRS. KITA S SAMUEL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 770-944-8208
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 075-R-0016
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------