Individual
JOHN WESLEY KING JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
250 MARTIN LUTHER KING JR BLVD, MACON, GA 31201-3490
(478) 301-4111
(478) 301-5812
Mailing address
250 MARTIN LUTHER KING JR BLVD, MACON, GA 31201-3490
(478) 301-2362
(478) 301-2272
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
021126
GA
207RP1001X
Pulmonary Disease Physician
Primary
021126
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00347608A
—
GA
01
—
021126
GEORGIA LICENSE
GA
01
—
52071710
BCBS GEORGIA
GA
01
—
581714951
CHAMPVA COMMERCIAL
GA
01
—
58171495131061
CHAMPUSTRICARETRICARLIFE
GA
Enumeration date
08/24/2005
Last updated
02/14/2017
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