Provider Demographics
NPI:1730966078
Name:KING, MYLES J
Entity type:Individual
Prefix:
First Name:MYLES
Middle Name:J
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 1:863 SPRINGFIELD CT
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-1583
Mailing Address - Country:US
Mailing Address - Phone:601-503-0116
Mailing Address - Fax:
Practice Address - Street 1:100 US-11
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:AL
Practice Address - Zip Code:35470
Practice Address - Country:US
Practice Address - Phone:205-652-3714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program