MEDICARE: CARL EDWARD KING JR. PA-C

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	363A00000X	Physician Assistant	683	SC
2	363A00000X	Physician Assistant	516	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	6067427	OTHER	TN	BCBS TN
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174563837
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARL EDWARD KING JR. PA-C

Provider Business Mailing Address
First Line	:	3024 BUSINESS PARK CIR
Second Line	:
City	:	GOODLETTSVILLE
State	:	TN
Zip	:	37072-3132
Country	:	US
Telephone Number	:	615-851-6033
Fax Number	:	615-851-2018

Provider Business Practice Location Address
First Line	:	131 FRENCH LANDING DR
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37228-1511
Country	:	US
Telephone Number	:	615-254-9981
Fax Number	:	615-254-9747

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

Provider Enumeration Date	:	06/08/2006
Last Update Date	:	03/21/2023

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