Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 14912 | SC |
Y | 207XS0106X | Orthopaedic Hand Surgeon | 14912 | SC |
NPI | 1285739219 |
---|---|
Provider Name | John A King |
First Address | Greenwood, SC 29646-2315 |
Second Address | Greenwood, SC 29646-2315 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2006 |
Last Update Date | 09/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D45865 | (02) | SC |