Healthcare Provider Details

I. General information

NPI: 1649362518
Provider Name (Legal Business Name): PAUL KING MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 01/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9075 SANDIDGE CENTER DR
OLIVE BRANCH MS
38654
US

IV. Provider business mailing address

PO BOX 341065
MEMPHIS TN
38184
US

V. Phone/Fax

Practice location:
  • Phone: 662-893-7101
  • Fax: 662-895-4403
Mailing address:
  • Phone: 901-385-2342
  • Fax: 901-382-0140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number10676
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number12763
License Number StateMS

VIII. Authorized Official

Name: DR. PAUL KING
Title or Position: PHYSICIAN
Credential: MD
Phone: 662-893-7101