Provider Demographics
NPI:1942587159
Name:AULT MCINNIS PLLC
Entity Type:Organization
Organization Name:AULT MCINNIS PLLC
Other - Org Name:FAMILY FIRST OF JACKSONVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:AULT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:903-284-6105
Mailing Address - Street 1:2116 E RUSK ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75766-9052
Mailing Address - Country:US
Mailing Address - Phone:903-284-6105
Mailing Address - Fax:903-284-6104
Practice Address - Street 1:2114 E RUSK ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:TX
Practice Address - Zip Code:75766-9052
Practice Address - Country:US
Practice Address - Phone:903-284-6105
Practice Address - Fax:903-284-6104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-16
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty