Provider Demographics
NPI:1306405246
Name:KING, LONNIE III
Entity Type:Individual
Prefix:MR
First Name:LONNIE
Middle Name:
Last Name:KING
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5288 BROOKSHIRE CT
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-5365
Mailing Address - Country:US
Mailing Address - Phone:404-351-0903
Mailing Address - Fax:877-570-2212
Practice Address - Street 1:5288 BROOKSHIRE CT
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-5365
Practice Address - Country:US
Practice Address - Phone:404-351-0903
Practice Address - Fax:877-570-2212
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-12
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant