Healthcare Provider Details

I. General information

NPI: 1740259514
Provider Name (Legal Business Name): RICHARD W KING JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2006
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 WINDY HILL RD SE
MARIETTA GA
30067-8607
US

IV. Provider business mailing address

2550 WINDY HILL RD SE SUITE 110
MARIETTA GA
30067-8607
US

V. Phone/Fax

Practice location:
  • Phone: 678-303-3200
  • Fax: 678-303-3205
Mailing address:
  • Phone: 678-303-3200
  • Fax: 678-303-3205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number21872
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number21872
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code2083P0011X
TaxonomyUndersea and Hyperbaric Medicine (Preventive Medicine) Physician
License Number21872
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number021872
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: