Provider Demographics
NPI:1912481482
Name:KJH MEDICAL SERVICES
Entity Type:Organization
Organization Name:KJH MEDICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:229-329-3295
Mailing Address - Street 1:PO BOX 128
Mailing Address - Street 2:
Mailing Address - City:SHELLMAN
Mailing Address - State:GA
Mailing Address - Zip Code:39886-0128
Mailing Address - Country:US
Mailing Address - Phone:229-679-2100
Mailing Address - Fax:229-679-2010
Practice Address - Street 1:67 W RAILROAD ST
Practice Address - Street 2:
Practice Address - City:SHELLMAN
Practice Address - State:GA
Practice Address - Zip Code:39886-3100
Practice Address - Country:US
Practice Address - Phone:229-679-2100
Practice Address - Fax:229-679-2010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-20
Last Update Date:2021-10-18
Deactivation Date:2021-09-18
Deactivation Code:
Reactivation Date:2021-10-18
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty