Provider Demographics
NPI:1124761150
Name:KING, MERIDITH ELISE HAWKINS (DO)
Entity type:Individual
Prefix:DR
First Name:MERIDITH
Middle Name:ELISE HAWKINS
Last Name:KING
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 VERMONT AVE
Mailing Address - Street 2:
Mailing Address - City:OAK RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37830-6471
Mailing Address - Country:US
Mailing Address - Phone:865-482-1777
Mailing Address - Fax:865-374-2117
Practice Address - Street 1:100 VERMONT AVE
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-6471
Practice Address - Country:US
Practice Address - Phone:865-482-1777
Practice Address - Fax:865-374-2117
Is Sole Proprietor?:No
Enumeration Date:2022-04-18
Last Update Date:2025-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6357207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ103196Medicaid