Provider Demographics
NPI:1124476346
Name:KING, SARAH MICHELLE (LAC)
Entity type:Individual
Prefix:MISS
First Name:SARAH
Middle Name:MICHELLE
Last Name:KING
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 COMMERCE DR
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:BLAIRSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30512-8912
Mailing Address - Country:US
Mailing Address - Phone:512-786-6927
Mailing Address - Fax:
Practice Address - Street 1:47 COMMERCE DR
Practice Address - Street 2:SUITE 1B
Practice Address - City:BLAIRSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30512-8912
Practice Address - Country:US
Practice Address - Phone:512-786-6927
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-27
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA383171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist