Provider Demographics
NPI:1770859563
Name:KING, VANESSA (CST, CPC-A)
Entity Type:Individual
Prefix:MS
First Name:VANESSA
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:CST, CPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 142765
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-6520
Mailing Address - Country:US
Mailing Address - Phone:770-987-9228
Mailing Address - Fax:770-629-2380
Practice Address - Street 1:145 FOREST HALL LN
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-4025
Practice Address - Country:US
Practice Address - Phone:770-987-9228
Practice Address - Fax:770-629-2380
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-27
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor