Provider Demographics
NPI:1770261042
Name:KING, SIERRA
Entity type:Individual
Prefix:
First Name:SIERRA
Middle Name:
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:PO BOX 91571
Mailing Address - Street 2:
Mailing Address - City:EAST POINT
Mailing Address - State:GA
Mailing Address - Zip Code:30364-1571
Mailing Address - Country:US
Mailing Address - Phone:470-485-6116
Mailing Address - Fax:
Practice Address - Street 1:4395 FULTON INDUSTRIAL BLVD SW STE D1262
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30336-1956
Practice Address - Country:US
Practice Address - Phone:404-485-6116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-07
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion
No171W00000XOther Service ProvidersContractor
No172A00000XOther Service ProvidersDriver
No376J00000XNursing Service Related ProvidersHomemaker