MEDICARE: JACOB KING

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	183500000X	Pharmacist	RPH035549	GA

General Provider Information

NPI Number	:	1295686822
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACOB KING

Provider Business Mailing Address
First Line	:	57 CHEROKEE ROSE RUN
Second Line	:
City	:	DALLAS
State	:	GA
Zip	:	30157-5013
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3950 AUSTELL RD
Second Line	:
City	:	AUSTELL
State	:	GA
Zip	:	30106-1121
Country	:	US
Telephone Number	:	770-732-4000
Fax Number	:

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

Provider Enumeration Date	:	02/09/2026
Last Update Date	:	02/09/2026

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Directions to “ JACOB KING ” Practice Location

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