Individual
RAE A KING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
750 TOWNPARK LN NW, KENNESAW, GA 30144-5579
(770) 514-5500
Mailing address
3495 PIEDMONT RD NE, ATLANTA, GA 30305-1717
(404) 364-7285
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
053319
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
593568511K
—
GA
05
—
593568511L
—
GA
05
—
593568511M
—
GA
05
—
593568511N
—
GA
05
—
593568511O
—
GA
Enumeration date
08/11/2005
Last updated
01/13/2022
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