Provider Demographics
NPI:1316584998
Name:KING, CARL L SR (ETC)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:L
Last Name:KING
Suffix:SR
Gender:M
Credentials:ETC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:384 GRIFFIN RD
Mailing Address - Street 2:
Mailing Address - City:BENTONIA
Mailing Address - State:MS
Mailing Address - Zip Code:39040-9062
Mailing Address - Country:US
Mailing Address - Phone:601-540-5522
Mailing Address - Fax:662-571-3452
Practice Address - Street 1:384 GRIFFIN RD
Practice Address - Street 2:
Practice Address - City:BENTONIA
Practice Address - State:MS
Practice Address - Zip Code:39040-9062
Practice Address - Country:US
Practice Address - Phone:601-540-5522
Practice Address - Fax:662-571-3452
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-03
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)