Provider Demographics
NPI:1558347807
Name:KING, MARSHALEEN N HENRIQUES (MD)
Entity Type:Individual
Prefix:DR
First Name:MARSHALEEN
Middle Name:N HENRIQUES
Last Name:KING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6001 PROFESSIONAL PKWY STE 2020
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30134-5632
Mailing Address - Country:US
Mailing Address - Phone:770-422-1372
Mailing Address - Fax:678-715-4910
Practice Address - Street 1:6001 PROFESSIONAL PKWY STE 2020
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134-5632
Practice Address - Country:US
Practice Address - Phone:770-422-1372
Practice Address - Fax:678-715-4910
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA056564207R00000X, 207RC0200X, 207RP1001X
MN103386207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN926450000Medicaid
MN290000564Medicare PIN