Individual
CLIFF L. KING
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
601A PROFESSIONAL DR STE 150, LAWRENCEVILLE, GA 30046-3325
(770) 963-6652
(770) 963-6013
Mailing address
601A PROFESSIONAL DR STE 150, LAWRENCEVILLE, GA 30046-3325
(770) 963-6652
(770) 963-6013
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
025993
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0282107
BC / BS OF GEORGIA
GA
01
—
11D0257597
CLIA
—
01
—
58-1627574
FEDERAL E.I.N.
—
Enumeration date
06/20/2005
Last updated
03/07/2023
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