Provider Demographics
NPI:1922402262
Name:FORSYTH AREA SPORTS TEAMS
Entity Type:Organization
Organization Name:FORSYTH AREA SPORTS TEAMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KINDREE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-697-6566
Mailing Address - Street 1:2645 PILGRIM MILL CIR
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-9074
Mailing Address - Country:US
Mailing Address - Phone:678-697-6566
Mailing Address - Fax:
Practice Address - Street 1:2645 PILGRIM MILL CIR
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-9074
Practice Address - Country:US
Practice Address - Phone:678-697-6566
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-15
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental MedicineGroup - Single Specialty