Charles Mark King, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

3681 Issued in AL

Practice address

6662 Highway 75
Suite 114
Pinson, AL 35126-3200

Phone

(205) 681-5959

Fax

(205) 681-5954

NPI assigned

Aug 1, 2006

Last updated

Jul 9, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in AL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1154390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1649287038",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6662 HIGHWAY 75",
            "address_2": "SUITE 114",
            "city": "PINSON",
            "state": "AL",
            "postal_code": "351263200",
            "telephone_number": "205-681-5959",
            "fax_number": "205-681-5954"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6662 HIGHWAY 75",
            "address_2": "SUITE 114",
            "city": "PINSON",
            "state": "AL",
            "postal_code": "351263200",
            "telephone_number": "205-681-5959",
            "fax_number": "205-681-5954"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KING",
        "first_name": "CHARLES",
        "middle_name": "MARK",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-01",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "AL",
            "license": "3681",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECROSSBLUESHIELD",
            "identifier": "01015",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dana N Johnson
• Tia De'Antranise Johnson
• Tonya Lynette Johnson, CRNP
• George Jolly, CRNP
• Ashley Nichole Kimbrough
• Chase Lash
• Clelata Lewis, FNP-C
• John Mark Lytle, MD
• Glinda Mauldin
• Tammy Marbury McClellan

• General Practice Dentistry in Pinson, AL
• Providers in Pinson, AL by specialty
• General Practice Dentistry in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.