Provider Demographics
NPI:1376957522
Name:KING, JONATHAN CALEB (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:CALEB
Last Name:KING
Suffix:
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 1:1401 3RD AVE N APT 511
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37208-3286
Mailing Address - Country:US
Mailing Address - Phone:304-546-1865
Mailing Address - Fax:
Practice Address - Street 1:3441 DICKERSON PIKE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37207
Practice Address - Country:US
Practice Address - Phone:615-769-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-16
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN55780207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine