Provider Demographics
NPI:1548423718
Name:KING, PAUL (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:KING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6911 PARKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:OLIVE BRANCH
Mailing Address - State:MS
Mailing Address - Zip Code:38654-2111
Mailing Address - Country:US
Mailing Address - Phone:901-216-4354
Mailing Address - Fax:888-858-1577
Practice Address - Street 1:9075 SANDIDGE CENTER DRIVE
Practice Address - Street 2:
Practice Address - City:OLIVE BRANCH
Practice Address - State:MS
Practice Address - Zip Code:38654
Practice Address - Country:US
Practice Address - Phone:662-893-7101
Practice Address - Fax:662-895-4403
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-08
Last Update Date:2019-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS127632084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00853276OtherMEDICAID GROUP
MS00016134OtherMEDICAID INDIVIDUAL
MS260000212OtherMEDICARE INDIVIDUAL PROVIDER