MEDICARE: WINTON KING MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	015785	GA

General Provider Information

NPI Number	:	1629094719
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WINTON KING MD

Provider Business Mailing Address
First Line	:	4850 REDAN RD
Second Line	:
City	:	STONE MOUNTAIN
State	:	GA
Zip	:	30088-2751
Country	:	US
Telephone Number	:	404-297-1818
Fax Number	:	404-297-1629

Provider Business Practice Location Address
First Line	:	4850 REDAN RD
Second Line	:
City	:	STONE MOUNTAIN
State	:	GA
Zip	:	30088-2751
Country	:	US
Telephone Number	:	404-297-1818
Fax Number	:	404-297-1629

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	07/08/2007

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Directions to “ WINTON KING MD” Practice Location

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