Provider Demographics
NPI:1932101284
Name:KING, MATTHEW J (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:J
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 1:3300 WILLIAMS ENTERPRISE DR STE 1
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38506-4224
Mailing Address - Country:US
Mailing Address - Phone:931-528-9222
Mailing Address - Fax:931-854-0907
Practice Address - Street 1:3300 WILLIAMS ENTERPRISE DR STE 1
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38506-4224
Practice Address - Country:US
Practice Address - Phone:931-528-9222
Practice Address - Fax:931-854-0907
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-01
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY35889207R00000X, 208000000X
TN39208208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4096784OtherBLUE CROSS BLUE SHIELD
TN3326198Medicaid
TN3326198Medicare PIN
TN4096784OtherBLUE CROSS BLUE SHIELD