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NPI Code Detail

MEDICARE: CHUNTAVIA KING RN

MEDICARE: CHUNTAVIA KING RN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered NurseRN245674GA

General Provider Information

NPI Number : 1427639673
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHUNTAVIA KING RN
Provider Business Mailing Address
First Line : 1922 SARATOGA DR
Second Line :
City : ALPHARETTA
State : GA
Zip : 30022-2891
Country : US
Telephone Number : 770-366-1226
Fax Number :
Provider Business Practice Location Address
First Line : 1922 SARATOGA DR
Second Line :
City : ALPHARETTA
State : GA
Zip : 30022-2891
Country : US
Telephone Number : 770-366-1226
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/19/2021
Last Update Date : 04/19/2021

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