Provider Demographics
NPI:1346320363
Name:KINSEY, GARY STEPHEN (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:STEPHEN
Last Name:KINSEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 349
Mailing Address - Street 2:4 NORTH MAIN STREET
Mailing Address - City:MAYSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30558-0349
Mailing Address - Country:US
Mailing Address - Phone:706-652-2252
Mailing Address - Fax:706-652-3444
Practice Address - Street 1:4 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MAYSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30558-1702
Practice Address - Country:US
Practice Address - Phone:706-652-2252
Practice Address - Fax:706-652-3444
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA030637207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
52238OtherBCBS
GA000367276AMedicaid
GA1346320363OtherNPI
GA1346320363OtherNPI
GA000367276AMedicaid
D40360Medicare UPIN