Provider Demographics
NPI:1164461315
Name:KING, JAMES CENTRE III (MD)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:CENTRE
Last Name:KING
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3024 BUSINESS PARK CIR
Mailing Address - Street 2:
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-3132
Mailing Address - Country:US
Mailing Address - Phone:615-851-6033
Mailing Address - Fax:615-851-2018
Practice Address - Street 1:3024 BUSINESS PARK CIR
Practice Address - Street 2:
Practice Address - City:GOODLETTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37072-3132
Practice Address - Country:US
Practice Address - Phone:615-851-6033
Practice Address - Fax:615-851-2018
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN190192085R0202X, 2085N0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00942161OtherRR MEDICARE - MTI
TN1509285Medicaid
TN4076235OtherBCBS
TN2550415OtherCIGNA
TN300108655OtherRAILROAD MEDICARE
TN3031170OtherBCBS
TN3135911OtherBCBS
TN4200812OtherBCBS TN
KY64924616OtherKY MEDICAID
TN1509285OtherMEDICAID - MTI
TN3083724Medicaid
TN4291333OtherBCBS - MTI
TN1640735OtherUNITED HEALTHCARE OF TN
TN3083723Medicaid
TN4291333OtherBCBS - MTI
P00942161OtherRR MEDICARE - MTI
TN3083727Medicare PIN
TN1509285OtherMEDICAID - MTI
TN300108655OtherRAILROAD MEDICARE
TN4200812OtherBCBS TN