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General NPI Number Information
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NPI Number | 1649362518
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Entity Type | Organization
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Legal Business Name | PAUL KING MD PC
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Dates
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Enumeration Date | 09/29/2006
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Last Update Date | 01/04/2008
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Provider Practice Location Address
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Address Line | 9075 SANDIDGE CENTER DR
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City | OLIVE BRANCH
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State | MS
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Zip | 38654
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Country | US
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Telephone | 662-893-7101
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Fax | 662-895-4403
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Provider Business Mailing Address
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Address Line | PO BOX 341065
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City | MEMPHIS
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State | TN
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Zip | 38184
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Country | US
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Telephone | 901-385-2342
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Fax | 901-382-0140
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. PAUL KING
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Credential | MD
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Telephone | 662-893-7101
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 10676
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 12763
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License Number State | MS
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