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Individual

TASHANDA KING

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
3526 MELODY DR, AUGUSTA, GA 30906-9533
(478) 268-1894
Mailing address
3526 MELODY DR, AUGUSTA, GA 30906-9533
(478) 268-1894

Taxonomy

Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
76806914
ADULT
Enumeration date
11/10/2020
Last updated
11/10/2020
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