| NPI | 1134880404 |
|---|---|
| Doing Business As | KOINONIA BAPTIST CHURCH |
| Entity Type | Organization |
| Authorized Contact | SHAVONDA L KEATING Director Of Provider Enrollment 410-933-6430 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207RE0101X Internal Medicine, Endocrinology, Diabetes & Metabolism |
| Enumeration Date | 2022-01-07 |
| Last Update Date | 2022-01-07 |