Provider Demographics
NPI:1710976428
Name:KING, JEFFREY SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:SCOTT
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 1:744 MIDDLE CREEK RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SEVIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37862-5015
Mailing Address - Country:US
Mailing Address - Phone:865-446-9550
Mailing Address - Fax:865-446-9551
Practice Address - Street 1:744 MIDDLE CREEK RD
Practice Address - Street 2:SUITE 210
Practice Address - City:SEVIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:37862-5036
Practice Address - Country:US
Practice Address - Phone:865-446-9550
Practice Address - Fax:865-446-9551
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-14
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYMD35963208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3884283Medicaid
H82716Medicare UPIN
3884283Medicare ID - Type Unspecified