Provider Demographics
NPI:1023081031
Name:KING, MARCY (FNP)
Entity type:Individual
Prefix:
First Name:MARCY
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:MARCY
Other - Middle Name:ANN
Other - Last Name:CHRISTMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:PO BOX 5007
Mailing Address - Street 2:
Mailing Address - City:CORDELE
Mailing Address - State:GA
Mailing Address - Zip Code:31010
Mailing Address - Country:US
Mailing Address - Phone:229-271-9330
Mailing Address - Fax:229-271-9245
Practice Address - Street 1:1329 N 5TH STREET EXT
Practice Address - Street 2:
Practice Address - City:CORDELE
Practice Address - State:GA
Practice Address - Zip Code:31015-3753
Practice Address - Country:US
Practice Address - Phone:229-273-9050
Practice Address - Fax:229-276-3641
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN119135363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000969383IMedicaid
GA50BBFMJMedicare ID - Type Unspecified
GA000969383IMedicaid