Healthcare Provider Details

I. General information

NPI: 1326201500
Provider Name (Legal Business Name): TERRY D. KING, MD AMC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2008
Last Update Date: 05/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 PAVILION RD
WEST MONROE LA
71292-9470
US

IV. Provider business mailing address

300 PAVILION RD
WEST MONROE LA
71292-9470
US

V. Phone/Fax

Practice location:
  • Phone: 318-323-1100
  • Fax: 318-323-1161
Mailing address:
  • Phone: 318-323-1100
  • Fax: 318-323-1161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License NumberMD.02443R
License Number StateLA

VIII. Authorized Official

Name: NANCY BATSON KING
Title or Position: CFO
Credential: PNP-BC
Phone: 318-323-1100