Provider Demographics
NPI:1457117012
Name:KING, ZAKIYYAH N
Entity type:Individual
Prefix:
First Name:ZAKIYYAH
Middle Name:N
Last Name:KING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4813 RIDGE RD STE 113
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30134-6120
Mailing Address - Country:US
Mailing Address - Phone:770-681-6865
Mailing Address - Fax:
Practice Address - Street 1:4813 RIDGE RD STE 113
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134-6120
Practice Address - Country:US
Practice Address - Phone:770-681-6865
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-22
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier