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General NPI Number Information
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NPI Number | 1538702170
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Entity Type | Individual
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Provider Name | MAYA TIFFANY JACQUELINE KING CPNP
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Gender | Female
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Dates
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Enumeration Date | 10/27/2019
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Last Update Date | 01/06/2026
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Provider Practice Location Address
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Address Line | 4503 ASHFORD DUNWOODY RD NE
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City | ATLANTA
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State | GA
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Zip | 30346-1509
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Country | US
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Telephone | 470-285-9588
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Fax | 470-285-9589
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Provider Business Mailing Address
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Address Line | 4503 ASHFORD DUNWOODY RD NE
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City | ATLANTA
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State | GA
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Zip | 30346-1509
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Country | US
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Telephone | 470-285-9588
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Fax | 470-285-9589
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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 | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 290689
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License Number State | GA
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