Provider Demographics
NPI:1689928525
Name:C.M. KINNARD, LLC
Entity Type:Organization
Organization Name:C.M. KINNARD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:M
Authorized Official - Last Name:KINNARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:478-287-6574
Mailing Address - Street 1:1118 HIGHWAY 96 WEST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:KATHLEEN
Mailing Address - State:GA
Mailing Address - Zip Code:31047
Mailing Address - Country:US
Mailing Address - Phone:478-287-6574
Mailing Address - Fax:478-287-6579
Practice Address - Street 1:1118 HIGHWAY 96 WEST
Practice Address - Street 2:SUITE 1
Practice Address - City:KATHLEEN
Practice Address - State:GA
Practice Address - Zip Code:31047
Practice Address - Country:US
Practice Address - Phone:478-287-6574
Practice Address - Fax:478-287-6579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-30
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA68822208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty