Provider Demographics
NPI:1295126977
Name:FAMILY MEDICINE PROFESSIONALS INC
Entity type:Organization
Organization Name:FAMILY MEDICINE PROFESSIONALS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DOREEN
Authorized Official - Middle Name:DARLYN
Authorized Official - Last Name:KINNEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-264-1278
Mailing Address - Street 1:3215 SHRINE RD
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-4387
Mailing Address - Country:US
Mailing Address - Phone:912-264-1278
Mailing Address - Fax:912-264-1044
Practice Address - Street 1:3215 SHRINE RD
Practice Address - Street 2:SUITE 1A
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-4387
Practice Address - Country:US
Practice Address - Phone:912-264-1278
Practice Address - Fax:912-264-1044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-17
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA042629207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00795792AMedicaid
GA080135122OtherRAILROAD MEDICARE
GA08BDPBQMedicare PIN
1316047376Medicare UPIN