Provider Demographics
NPI:1730143009
Name:KING, MARY ANN (DO)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ANN
Last Name:KING
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Gender:F
Credentials:DO
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Mailing Address - Street 1:900 EARL FRYE BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:AMORY
Mailing Address - State:MS
Mailing Address - Zip Code:38821-5507
Mailing Address - Country:US
Mailing Address - Phone:662-256-9331
Mailing Address - Fax:662-256-9349
Practice Address - Street 1:900 EARL FRYE BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:AMORY
Practice Address - State:MS
Practice Address - Zip Code:38821-5507
Practice Address - Country:US
Practice Address - Phone:662-256-9331
Practice Address - Fax:662-256-9349
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2016-09-02
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Provider Licenses
StateLicense IDTaxonomies
MS14668208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00126569Medicaid
MSMPP000Medicare UPIN