1598217481 NPI number — MRS. LAKEYSHIA NIX KING NP-C

Table of content: MRS. LAKEYSHIA NIX KING NP-C (NPI 1598217481)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598217481 NPI number — MRS. LAKEYSHIA NIX KING NP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KING
Provider First Name:
LAKEYSHIA
Provider Middle Name:
NIX
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
NP-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598217481
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/29/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
201 2ND ST STE 1100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MACON
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31201-6328
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
229-291-0900
Provider Business Mailing Address Fax Number:
478-751-6099

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1600 FORSYTH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MACON
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31201-1408
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
478-745-0411
Provider Business Practice Location Address Fax Number:
478-749-0101
Provider Enumeration Date:
10/26/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  RN217598 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 003183911G , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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