Basic Information
| Provider Information | |||||||||
| NPI: | 1144256157 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KING | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | DARREL | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 PRIME CARE DR | ||||||||
| Address2: | |||||||||
| City: | SELMER | ||||||||
| State: | TN | ||||||||
| PostalCode: | 383751864 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7316457932 | ||||||||
| FaxNumber: | 7316455195 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 PRIME CARE DR | ||||||||
| Address2: | |||||||||
| City: | SELMER | ||||||||
| State: | TN | ||||||||
| PostalCode: | 383751864 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7316457932 | ||||||||
| FaxNumber: | 7316455195 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2006 | ||||||||
| LastUpdateDate: | 11/19/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 14266 | TN | Y | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 16404 | MS | N | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 116900 | 05 | TN | MEDICAID | 12048 | 05 | TN | MEDICAID | 3123017 | 01 | TN | BLUE CROSS BLUE SHIELD S | OTHER | 3717101 | 05 | TN | MEDICAID | 3123019 | 01 | TN | BLUE CROSS BLUE SHIELD H | OTHER | 3124181 | 01 | TN | BLUE CROSS BLUE SHIELD A | OTHER |