Provider Demographics
NPI:1255980389
Name:KING, ALAN EARL (PA-C)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:EARL
Last Name:KING
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 DENSO DR
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:TN
Mailing Address - Zip Code:37303-7835
Mailing Address - Country:US
Mailing Address - Phone:423-745-0303
Mailing Address - Fax:423-745-0306
Practice Address - Street 1:2400 DENSO DR
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TN
Practice Address - Zip Code:37303-7835
Practice Address - Country:US
Practice Address - Phone:423-745-0303
Practice Address - Fax:423-745-0306
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-11
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61786363A00000X
363A00000X
GA11693363A00000X
NVPA2240363A00000X
TN3985363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant