Provider Demographics
NPI:1326722133
Name:KING, ANNIE V (LHAD)
Entity Type:Individual
Prefix:
First Name:ANNIE
Middle Name:V
Last Name:KING
Suffix:
Gender:F
Credentials:LHAD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1468 BRIARWOOD RD NE UNIT 1903
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:GA
Mailing Address - Zip Code:30319-5745
Mailing Address - Country:US
Mailing Address - Phone:313-643-7296
Mailing Address - Fax:
Practice Address - Street 1:2430 ATLANTA RD SE STE 100
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-2024
Practice Address - Country:US
Practice Address - Phone:770-425-1095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001109237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist