Provider Demographics
NPI:1093877508
Name:KING, JAMES G (PA)
Entity Type:Individual
Prefix:PROF
First Name:JAMES
Middle Name:G
Last Name:KING
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:168 13TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:TN
Mailing Address - Zip Code:37398-1071
Mailing Address - Country:US
Mailing Address - Phone:205-712-3246
Mailing Address - Fax:931-507-2274
Practice Address - Street 1:1012 S CHANCERY ST
Practice Address - Street 2:
Practice Address - City:MC MINNVILLE
Practice Address - State:TN
Practice Address - Zip Code:37110-3704
Practice Address - Country:US
Practice Address - Phone:931-507-2273
Practice Address - Fax:931-507-2274
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNPA453363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNS05289Medicare UPIN