Organization
KINGDOM HEALTHCARE SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LUCILLE M TRAVIS NP (CEO)
(678) 978-4947
Entity
Organization
Contact information
Practice address
4095 ATLANTA HWY, HIRAM, GA 30141-1854
(404) 488-9521
Mailing address
4095 ATLANTA HWY, HIRAM, GA 30141-1854
(404) 488-9521
Taxonomy
Speciality
Code
Description
License number
State
251J00000X
Nursing Care Agency
—
—
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Enumeration date
02/11/2020
Last updated
10/22/2023
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