Provider Demographics
NPI:1639145253
Name:KING, BERNARDINE M (MD)
Entity Type:Individual
Prefix:MRS
First Name:BERNARDINE
Middle Name:M
Last Name:KING
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Gender:F
Credentials:MD
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Mailing Address - Street 1:535 JESSE JEWELL PARKWAY
Mailing Address - Street 2:SUITE C
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501
Mailing Address - Country:US
Mailing Address - Phone:770-534-9014
Mailing Address - Fax:770-534-9012
Practice Address - Street 1:535 JESSE JEWELL PARKWAY
Practice Address - Street 2:SUITE C
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501
Practice Address - Country:US
Practice Address - Phone:770-534-9014
Practice Address - Fax:770-534-9012
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2015-07-17
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Provider Licenses
StateLicense IDTaxonomies
GA042071207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00735281AMedicaid
GA000735281GMedicaid
GA202I061032Medicare PIN
GA00735281AMedicaid
GA06BDFKNMedicare PIN