Provider Demographics
NPI:1952340408
Name:KING, ROBERT T III (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:T
Last Name:KING
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 102635
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368-2635
Mailing Address - Country:US
Mailing Address - Phone:912-354-4800
Mailing Address - Fax:912-629-4821
Practice Address - Street 1:4720 WATERS AVE
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31404-6292
Practice Address - Country:US
Practice Address - Phone:912-354-4800
Practice Address - Fax:912-629-4821
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2017-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SCMD 17647207W00000X
GA032337207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000613863CMedicaid
SCGPA977OtherMEDICAID GRP.- SAV
GA1952340408OtherMEDICARE RAILROAD
GA349792OtherWELLCARE OF GA
GA000613863EOtherMEDICAID- RINCON
GA10053760OtherAMERIGROUP
SCG32337Medicaid
GA000613863BMedicaid
GA000613863AMedicaid
GA000613863DOtherMEDICAID- BORO
GA000613863FOtherMEDICAID - SAVANNAH
SC1952340408OtherMEDICARE RAILROAD
SCGP5020OtherMEDICAID GRP. BLUFFTON
GA10053760OtherAMERIGROUP
GA1952340408OtherMEDICARE RAILROAD
GA6150410004Medicare NSC
GA180019131Medicare PIN
SCG32337Medicaid
GA0412940004Medicare NSC
GA6150410001Medicare NSC
GA18BDCSNMedicare PIN
GA000613863EOtherMEDICAID- RINCON
GA000613863AMedicaid
GA6150410005Medicare NSC
GA0412940001Medicare NSC
SCAA18705109Medicare PIN
GA0412940005Medicare NSC