Individual
JONATHAN D KING
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
157 CORLEY MILL RD, STE 510, LEXINGTON, SC 29072-7600
(803) 256-2483
(803) 799-4624
Mailing address
157 CORLEY MILL ROAD, LEXINGTON, SC 29072
(803) 256-2483
(803) 799-4624
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
19193
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
040011784
RAILROAD MEDICARE
—
05
—
191937
—
SC
01
—
621111
SELECT HEALTH
—
01
—
C14633
RAILROAD MEDICARE GRP NUMBER
—
01
—
PA1382
MEDICAID GROUP NUMBER
—
Enumeration date
06/09/2006
Last updated
11/07/2014
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