Provider Demographics
NPI:1235707118
Name:KING, CARLY JOY (MT-BC, LP-MT)
Entity Type:Individual
Prefix:MISS
First Name:CARLY
Middle Name:JOY
Last Name:KING
Suffix:
Gender:F
Credentials:MT-BC, LP-MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:470 CLOVER ST
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-2608
Mailing Address - Country:US
Mailing Address - Phone:706-380-3043
Mailing Address - Fax:
Practice Address - Street 1:470 CLOVER ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-2608
Practice Address - Country:US
Practice Address - Phone:706-380-3043
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-16
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA16434225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist