Provider Demographics
NPI:1356623235
Name:KING, ANDREW R (MD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:R
Last Name:KING
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:777 HEMLOCK ST
Mailing Address - Street 2:MSC 69
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-2102
Mailing Address - Country:US
Mailing Address - Phone:478-633-1700
Mailing Address - Fax:478-633-7032
Practice Address - Street 1:777 HEMLOCK ST
Practice Address - Street 2:MSC 69
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-2102
Practice Address - Country:US
Practice Address - Phone:478-633-1700
Practice Address - Fax:478-633-7032
Is Sole Proprietor?:No
Enumeration Date:2011-09-15
Last Update Date:2022-04-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
390200000X
GA816492085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program