Provider Demographics
NPI:1023756368
Name:KING, ADRIAN MONIQUE (PP)
Entity type:Individual
Prefix:
First Name:ADRIAN
Middle Name:MONIQUE
Last Name:KING
Suffix:
Gender:F
Credentials:PP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6900 SCHOMBURG RD APT 304
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31909-1511
Mailing Address - Country:US
Mailing Address - Phone:706-888-7503
Mailing Address - Fax:
Practice Address - Street 1:2100 COMER AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-8725
Practice Address - Country:US
Practice Address - Phone:706-596-5500
Practice Address - Fax:706-596-5727
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-26
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)