Provider Demographics
NPI:1225028988
Name:KING, ANNAH M (OTR/L, CHT)
Entity Type:Individual
Prefix:
First Name:ANNAH
Middle Name:M
Last Name:KING
Suffix:
Gender:F
Credentials:OTR/L, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 GASTON AVE
Mailing Address - Street 2:SUITE 450
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-1800
Mailing Address - Country:US
Mailing Address - Phone:214-823-5351
Mailing Address - Fax:214-823-2060
Practice Address - Street 1:3600 GASTON AVE
Practice Address - Street 2:SUITE 450
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-1800
Practice Address - Country:US
Practice Address - Phone:214-823-5351
Practice Address - Fax:214-823-2060
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX106824174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX106824OtherSTATE LICENSE#