Provider Demographics
NPI:1528343746
Name:KING, CHERYL W
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:W
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 1:2175 PARKLAKE DR NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30345-2845
Mailing Address - Country:US
Mailing Address - Phone:770-496-7505
Mailing Address - Fax:678-261-1470
Practice Address - Street 1:2175 PARKLAKE DR NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30345-2845
Practice Address - Country:US
Practice Address - Phone:770-496-7505
Practice Address - Fax:678-261-1470
Is Sole Proprietor?:No
Enumeration Date:2011-10-19
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5788183500000X
GA16691183500000X
TN11964183500000X
NC15767183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist