MEDICARE: DR. OLIVER W. KING M.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	174400000X	Specialist	D29931	GA

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	:	1669465472
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. OLIVER W. KING M.D

Provider Business Mailing Address
First Line	:	1505 STONEBRIDGE PARKWAY
Second Line	:	SUITE 100
City	:	WOODSTOCK
State	:	GA
Zip	:	30189-8282
Country	:	US
Telephone Number	:	770-423-0595
Fax Number	:	770-874-1614

Provider Business Practice Location Address
First Line	:	61 WHITCHER STREET NE
Second Line	:	SUITE 2100
City	:	MARIETTA
State	:	GA
Zip	:	30060-1179
Country	:	US
Telephone Number	:	770-423-0595
Fax Number	:	770-874-1614

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

Provider Enumeration Date	:	08/26/2005
Last Update Date	:	04/11/2012

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