Individual
JUSTIN M KING
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
363AS0400X
Surgical Physician Assistant
4112
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA4112
NCCPA
TN
Enumeration date
04/30/2020
Last updated
08/13/2020
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