Organization Active NPI

Richard W King Jr

  • Undersea and Hyperbaric Medicine (Emergency Medicine) Physician
  • Marietta, GA
National Provider Identifier
1083884803
Registry record updated Jun 10, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Undersea and Hyperbaric Medicine (Emergency Medicine) PhysicianTaxonomy code 207PE0005X
License
31517 Issued in GA
Legal business name
RICHARD W KING JR
Practice address
2550 Windy Hill Rd SE
Suite 110
Marietta, GA 30067-8665
Phone
(678) 303-3200
Fax
(678) 303-3205
NPI assigned
Mar 7, 2008
Last updated
Jun 10, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Reita King
Title
Part Owner
Phone
(678) 303-3200

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Undersea and Hyperbaric Medicine (Emergency Medicine) Physician 207PE0005X 31517 GA Primary
Physical Medicine & Rehabilitation Physician 208100000X 021872 GA
Rehabilitation Practitioner 225400000X GA021872 GA

Addresses

Primary practice location

2550 Windy Hill Rd SE
Suite 110
Marietta, GA 30067-8665

Mailing address

2550 Windy Hill Rd SE
Suite 110
Marietta, GA 30067-8665
Phone (678) 303-3200

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080607000046 GA Part B Supplier - Clinic/Group Practice 8527138221 Receives reassigned benefits from 1 practitioner
Practice locations: Marietta, GA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
11D1023874Richard W King Jr MD2550 Windy Hill Road, Suite 110, Marietta, GA 30067Certificate of waiverMar 28, 2028

National Provider Directory

National Provider Directory
Tax ID family
Richard W King Jr MD2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

500 Medical Center Blvd
Ste 100
Lawrenceville, GA 30046
Phone (770) 682-6000

500 Medical Center Blvd
Ste 170
Lawrenceville, GA 30046
Phone (678) 303-3200

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1204848000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1402358400000",
    "number": "1083884803",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2550 WINDY HILL RD SE",
            "address_2": "SUITE 110",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300678665",
            "telephone_number": "678-303-3200",
            "fax_number": "678-303-3205"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2550 WINDY HILL RD SE",
            "address_2": "SUITE 110",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300678665",
            "telephone_number": "678-303-3200",
            "fax_number": "678-303-3205"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RICHARD W KING JR",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-07",
        "last_updated": "2014-06-10",
        "status": "A",
        "authorized_official_last_name": "KING",
        "authorized_official_first_name": "REITA",
        "authorized_official_title_or_position": "PART OWNER",
        "authorized_official_telephone_number": "678-303-3200",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207PE0005X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Undersea and Hyperbaric Medicine",
            "state": "GA",
            "license": "31517",
            "primary": true
        },
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "GA",
            "license": "021872",
            "primary": false
        },
        {
            "code": "225400000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Practitioner",
            "state": "GA",
            "license": "GA021872",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Marietta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.