Provider Demographics
NPI:1740259514
Name:KING, RICHARD W JR (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:W
Last Name:KING
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2550 WINDY HILL RD SE SUITE 110
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-8607
Mailing Address - Country:US
Mailing Address - Phone:678-303-3200
Mailing Address - Fax:678-303-3205
Practice Address - Street 1:2550 WINDY HILL RD SE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-8607
Practice Address - Country:US
Practice Address - Phone:678-303-3200
Practice Address - Fax:678-303-3205
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA021872225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00271312CMedicaid
GAD45868Medicare UPIN
GAGRP3663Medicare ID - Type Unspecified