MEDICARE: DR. RICHARD W KING JR. M.D.

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	225400000X	Rehabilitation Practitioner	021872	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1740259514
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD W KING JR. M.D.

Provider Business Mailing Address
First Line	:	2550 WINDY HILL RD SE SUITE 110
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30067-8607
Country	:	US
Telephone Number	:	678-303-3200
Fax Number	:	678-303-3205

Provider Business Practice Location Address
First Line	:	2550 WINDY HILL RD SE
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30067-8607
Country	:	US
Telephone Number	:	678-303-3200
Fax Number	:	678-303-3205

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

Provider Enumeration Date	:	03/15/2006
Last Update Date	:	07/08/2007

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