Provider Demographics
NPI:1578273033
Name:KINSEY, AUSTIN DALE
Entity Type:Individual
Prefix:
First Name:AUSTIN
Middle Name:DALE
Last Name:KINSEY
Suffix:
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 1:162 HIGHWAY 123
Mailing Address - Street 2:
Mailing Address - City:TOCCOA
Mailing Address - State:GA
Mailing Address - Zip Code:30577-6711
Mailing Address - Country:US
Mailing Address - Phone:706-716-2796
Mailing Address - Fax:
Practice Address - Street 1:162 HIGHWAY 123
Practice Address - Street 2:
Practice Address - City:TOCCOA
Practice Address - State:GA
Practice Address - Zip Code:30577-6711
Practice Address - Country:US
Practice Address - Phone:706-716-2796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-24
Last Update Date:2022-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service