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General NPI Number Information
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NPI Number | 1083884803
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Entity Type | Organization
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Legal Business Name | RICHARD W KING JR
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Dates
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Enumeration Date | 03/07/2008
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Last Update Date | 06/10/2014
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Provider Practice Location Address
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Address Line | 2550 WINDY HILL RD SE SUITE 110
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City | MARIETTA
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State | GA
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Zip | 30067-8665
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Country | US
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Telephone | 678-303-3200
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Fax | 678-303-3205
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Provider Business Mailing Address
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Address Line | 2550 WINDY HILL RD SE SUITE 110
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City | MARIETTA
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State | GA
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Zip | 30067-8665
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Country | US
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Telephone | 678-303-3200
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Fax | 678-303-3205
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Authorized Official
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Title or Position | PART OWNER
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Name | MRS. REITA KING
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Credential |
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Telephone | 678-303-3200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225400000X
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Taxonomy Name | Rehabilitation Practitioner
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License Number | GA021872
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 021872
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 207PE0005X
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Taxonomy Name | Undersea and Hyperbaric Medicine (Emergency Medicine) Physician
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License Number | 31517
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License Number State | GA
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