Healthcare Provider Details

I. General information

NPI: 1710961719
Provider Name (Legal Business Name): ALLISON SHIVERS KING MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2005
Last Update Date: 11/14/2025
Certification Date: 11/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MEDICAL CENTER BLVD
WINSTON SALEM NC
27157-0001
US

IV. Provider business mailing address

100 KIMEL FOREST DR
WINSTON SALEM NC
27103-6074
US

V. Phone/Fax

Practice location:
  • Phone: 336-716-9252
  • Fax: 336-713-9387
Mailing address:
  • Phone: 336-716-2255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2005-01004
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number2005-01004
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number200501004
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier3810003470
Identifier TypeMEDICAID
Identifier StateWV
Identifier Issuer
# 2
IdentifierQ04006
Identifier TypeMEDICAID
Identifier StateSC
Identifier Issuer
# 3
Identifier10208696
Identifier TypeMEDICAID
Identifier StateVA
Identifier Issuer
# 4
Identifier5901150
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer
# 5
Identifier7313790
Identifier TypeOTHER
Identifier State
Identifier IssuerAETNA
# 6
IdentifierE3872
Identifier TypeOTHER
Identifier StateNC
Identifier IssuerMEDCOST
# 7
Identifier1392F
Identifier TypeOTHER
Identifier StateNC
Identifier IssuerBCBS
# 8
Identifier806758
Identifier TypeOTHER
Identifier StateNC
Identifier IssuerPARTNERS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: