Provider Demographics
NPI:1831274026
Name:KING, LUNSFORD RICHARDSON JR (MD)
Entity type:Individual
Prefix:DR
First Name:LUNSFORD
Middle Name:RICHARDSON
Last Name:KING
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 602172
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-2172
Mailing Address - Country:US
Mailing Address - Phone:704-348-4929
Mailing Address - Fax:704-348-5846
Practice Address - Street 1:2131 SOUTH 17TH STREET
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7407
Practice Address - Country:US
Practice Address - Phone:910-343-7597
Practice Address - Fax:910-791-6890
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2010-04-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC2001003922084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCQ0039NMedicaid
NC338926OtherVALUE OPTIONS
NC7254255OtherAETNA
NC891286VMedicaid
NC268476000OtherMAGELLAN
NC1286VOtherBLUE CROSS BLUE SHIELD
NC1286VOtherBLUE CROSS BLUE SHIELD
NC338926OtherVALUE OPTIONS
NCH43436Medicare UPIN