Individual
PAUL KING
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
9075 SANDIDGE CENTER DRIVE, OLIVE BRANCH, MS 38654
(662) 893-7101
(662) 895-4403
Mailing address
6911 PARKWOOD DR, OLIVE BRANCH, MS 38654-2111
(901) 216-4354
(888) 858-1577
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
12763
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00016134
MEDICAID INDIVIDUAL
MS
01
—
00853276
MEDICAID GROUP
MS
01
—
260000212
MEDICARE INDIVIDUAL PROVIDER
MS
Enumeration date
07/08/2008
Last updated
08/18/2019
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