Provider Demographics
NPI:1063196392
Name:KHAMA, KING AWENATE
Entity type:Individual
Prefix:
First Name:KING
Middle Name:AWENATE
Last Name:KHAMA
Suffix:
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 1:3900 GREENCASTLE RIDGE DR APT 401
Mailing Address - Street 2:
Mailing Address - City:BURTONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20866-2185
Mailing Address - Country:US
Mailing Address - Phone:301-278-6501
Mailing Address - Fax:
Practice Address - Street 1:3900 GREENCASTLE RIDGE DR APT 401
Practice Address - Street 2:
Practice Address - City:BURTONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20866-2185
Practice Address - Country:US
Practice Address - Phone:301-278-6501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-15
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator