Provider Demographics
NPI:1366648644
Name:MAYSVILLE FAMILY PRACTICE, INC
Entity Type:Organization
Organization Name:MAYSVILLE FAMILY PRACTICE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:KINSEY
Authorized Official - Suffix:
Authorized Official - Credentials:OM
Authorized Official - Phone:706-652-2252
Mailing Address - Street 1:PO BOX 349
Mailing Address - Street 2:
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 1:14 HOMER STREET
Practice Address - Street 2:
Practice Address - City:MAYSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30558-1738
Practice Address - Country:US
Practice Address - Phone:706-652-2252
Practice Address - Fax:706-652-3444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA030637207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1346320363OtherNPI
GA=========OtherTAX ID
GAD40360Medicare UPIN