Provider Demographics
NPI:1225150345
Name:THE KESSLER COMMUNITY CLINIC, INC.
Entity Type:Organization
Organization Name:THE KESSLER COMMUNITY CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:ABRAMS
Authorized Official - Last Name:GREENE
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MSN, GNP
Authorized Official - Phone:706-492-4045
Mailing Address - Street 1:PO BOX 321
Mailing Address - Street 2:
Mailing Address - City:MC CAYSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30555-0321
Mailing Address - Country:US
Mailing Address - Phone:706-492-4045
Mailing Address - Fax:
Practice Address - Street 1:43 EAST TENNESSEE AVE
Practice Address - Street 2:
Practice Address - City:MCCAYSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30555
Practice Address - Country:US
Practice Address - Phone:706-492-4045
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPENDING261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA8302313OtherOTHER
GAQ38679Medicare UPIN
GA50BBJDTMedicare ID - Type Unspecified