Provider Demographics
NPI:1750464855
Name:KINSELL, KAREN SUE (MD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:SUE
Last Name:KINSELL
Suffix:
Gender:F
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 4207
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31208-4207
Mailing Address - Country:US
Mailing Address - Phone:229-768-3888
Mailing Address - Fax:229-768-3889
Practice Address - Street 1:305 WASHINGTON ST S
Practice Address - Street 2:
Practice Address - City:FORT GAINES
Practice Address - State:GA
Practice Address - Zip Code:39851-4315
Practice Address - Country:US
Practice Address - Phone:229-768-3888
Practice Address - Fax:229-768-3889
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA042630207R00000X, 2083P0901X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
Not Answered208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA52508388 005OtherBCBS PROVIDER #
GA11BDPJTMedicare ID - Type UnspecifiedMEDICARE PROVIDER #