Provider Demographics
NPI:1376742551
Name:WILLIAM D KING
Entity Type:Organization
Organization Name:WILLIAM D KING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:D
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-687-2494
Mailing Address - Street 1:324 MACON ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:EUFAULA
Mailing Address - State:AL
Mailing Address - Zip Code:36027-1810
Mailing Address - Country:US
Mailing Address - Phone:334-687-2494
Mailing Address - Fax:334-687-5584
Practice Address - Street 1:324 MACON ST
Practice Address - Street 2:SUITE 2
Practice Address - City:EUFAULA
Practice Address - State:AL
Practice Address - Zip Code:36027-1810
Practice Address - Country:US
Practice Address - Phone:334-687-2494
Practice Address - Fax:334-687-5584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-17
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL11000207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL515-21355OtherBCBS
AL51011753OtherBCBSAL
AL000011753Medicaid
GA00265537A4OtherMEDICAID
AL51011753OtherBCBSAL
AL515-21355OtherBCBS
ALC73576Medicare UPIN
AL000011753Medicare PIN