MEDICARE: KEVIN RICHARD KING MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208M00000X	Hospitalist Physician	056310	GA
2	208M00000X	Hospitalist Physician	42356	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104808294
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN RICHARD KING MD

Provider Business Mailing Address
First Line	:	PO BOX 370
Second Line	:
City	:	FORTSON
State	:	GA
Zip	:	31808-0370
Country	:	US
Telephone Number	:	706-494-3072
Fax Number	:	706-494-3008

Provider Business Practice Location Address
First Line	:	4401 RIVERCHASE DR
Second Line	:
City	:	PHENIX CITY
State	:	AL
Zip	:	36867-7483
Country	:	US
Telephone Number	:	334-732-3000
Fax Number	:	706-494-3008

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/15/2005
Last Update Date	:	04/12/2021

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