Provider Demographics
NPI:1114750825
Name:KING, TERRENCE R
Entity type:Individual
Prefix:
First Name:TERRENCE
Middle Name:R
Last Name:KING
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 MOUNTAIN SPRINGS CV
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:GA
Mailing Address - Zip Code:30157-1217
Mailing Address - Country:US
Mailing Address - Phone:888-635-1022
Mailing Address - Fax:833-390-1531
Practice Address - Street 1:31 MOUNTAIN SPRINGS CV
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30157-1217
Practice Address - Country:US
Practice Address - Phone:888-635-1022
Practice Address - Fax:833-390-1531
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-20
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator