Provider Demographics
NPI:1174563837
Name:KING, CARL EDWARD JR (PA-C)
Entity type:Individual
Prefix:
First Name:CARL
Middle Name:EDWARD
Last Name:KING
Suffix:JR
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3024 BUSINESS PARK CIR
Mailing Address - Street 2:
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-3132
Mailing Address - Country:US
Mailing Address - Phone:615-851-6033
Mailing Address - Fax:615-851-2018
Practice Address - Street 1:131 FRENCH LANDING DR
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37228-1511
Practice Address - Country:US
Practice Address - Phone:615-254-9981
Practice Address - Fax:615-254-9747
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC683363A00000X
TN516363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN6067427OtherBCBS TN
TNQ004744Medicaid
TN3669278Medicaid
TN3669278Medicaid
P72984Medicare UPIN
TN103I977425Medicare PIN