Basic Information
| Provider Information | |||||||||
| NPI: | 1780687269 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KING | ||||||||
| FirstName: | GREGORY | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 367 WEST EVANS STREET | ||||||||
| Address2: | |||||||||
| City: | FLORENCE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295013429 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8436694156 | ||||||||
| FaxNumber: | 8436642121 | ||||||||
| Practice Location | |||||||||
| Address1: | 365 W WESMARK BLVD | ||||||||
| Address2: | |||||||||
| City: | SUMTER | ||||||||
| State: | SC | ||||||||
| PostalCode: | 291501987 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8039058020 | ||||||||
| FaxNumber: | 8039058025 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2005 | ||||||||
| LastUpdateDate: | 09/02/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/02/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | 22324 | SC | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | 9624212 | 01 | SC | GHI | OTHER | 180041867 | 01 | SC | RAILROAD MEDICARE | OTHER | 20027625 | 01 | SC | SELECT HEALTH | OTHER | 223243 | 05 | SC | MEDICAID | 433662 | 01 | SC | PRIVATE HEALTHCARE SYSTEM | OTHER | S327578 | 01 | SC | CIGNA | OTHER | 5467484 | 01 | SC | AETNA | OTHER |