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General NPI Number Information
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NPI Number | 1477789477
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Entity Type | Organization
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Legal Business Name | CHRIST THE KING HEALTHCARE PC
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Dates
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Enumeration Date | 06/04/2009
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Last Update Date | 04/23/2024
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Provider Practice Location Address
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Address Line | 3531-3533 HIGHWAY 81 SOUTH
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City | LOGANVILLE
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State | GA
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Zip | 30052
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Country | US
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Telephone | 770-554-2555
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Fax |
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Provider Business Mailing Address
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Address Line | 3531-3533 HIGHWAY 81 SOUTH
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City | LOGANVILLE
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State | GA
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Zip | 30052
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | CONSTANCE GEORGE-ADEBAYO
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Credential | MD
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Telephone | 770-554-2555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 060582
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License Number State | GA
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