MEDICARE: DR. JASON KING PH.D.

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	103TC0700X	Clinical Psychologist	PSY002888	GA

General Provider Information

NPI Number	:	1215157169
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JASON KING PH.D.

Provider Business Mailing Address
First Line	:	2400 LAKE PARK DR SE STE 110
Second Line	:
City	:	SMYRNA
State	:	GA
Zip	:	30080-8979
Country	:	US
Telephone Number	:	770-933-4130
Fax Number	:	770-933-4130

Provider Business Practice Location Address
First Line	:	2400 LAKE PARK DR SE STE 110
Second Line	:
City	:	SMYRNA
State	:	GA
Zip	:	30080-8979
Country	:	US
Telephone Number	:	770-933-4130
Fax Number	:	770-933-4130

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

Provider Enumeration Date	:	04/25/2007
Last Update Date	:	05/29/2026

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