MEDICARE: WILLA COBB KING

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
1	1041C0700X	Clinical Social Worker	SWC.0000002325	CO

General Provider Information

NPI Number	:	1689536484
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLA COBB KING

Provider Business Mailing Address
First Line	:	PO BOX 748465
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-8465
Country	:	US
Telephone Number	:	855-284-7483
Fax Number	:	617-807-0958

Provider Business Practice Location Address
First Line	:	9200 W CROSS DR STE 514
Second Line	:
City	:	LITTLETON
State	:	CO
Zip	:	80123-0761
Country	:	US
Telephone Number	:	303-376-8376
Fax Number	:	617-807-0958

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/01/2025
Last Update Date	:	12/01/2025

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