Provider Demographics
NPI:1538865878
Name:KING, ERNEST WADE JR
Entity type:Individual
Prefix:MR
First Name:ERNEST
Middle Name:WADE
Last Name:KING
Suffix:JR
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 1:309 ROBIN DR
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-9218
Mailing Address - Country:US
Mailing Address - Phone:601-255-5264
Mailing Address - Fax:
Practice Address - Street 1:32 MILLBRANCH RD
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-1672
Practice Address - Country:US
Practice Address - Phone:601-255-5264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-07
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician