Provider Demographics
NPI:1013139906
Name:KING, DENNIS R (MD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:R
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 1:11416 GRIGSBY CHAPEL RD STE 102
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37934-1770
Mailing Address - Country:US
Mailing Address - Phone:865-392-1717
Mailing Address - Fax:865-392-1719
Practice Address - Street 1:11416 GRIGSBY CHAPEL RD STE 102
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37934-1770
Practice Address - Country:US
Practice Address - Phone:865-392-1717
Practice Address - Fax:865-392-1719
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA241884207Q00000X
GA40938207Q00000X
TN25725207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003109868AMedicaid
GA202I082355Medicare Oscar/Certification
FG4565Medicare UPIN