Provider Demographics
NPI:1316078652
Name:WOGHIREN, KINGS
Entity type:Individual
Prefix:
First Name:KINGS
Middle Name:
Last Name:WOGHIREN
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 1:2470 WINDY HILL RD SE
Mailing Address - Street 2:222
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-8613
Mailing Address - Country:US
Mailing Address - Phone:678-858-1843
Mailing Address - Fax:678-574-0086
Practice Address - Street 1:2470 WINDY HILL RD SE
Practice Address - Street 2:222
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-8613
Practice Address - Country:US
Practice Address - Phone:678-858-1843
Practice Address - Fax:678-574-0086
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAO33R0070374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide