Provider Demographics
NPI:1932252004
Name:CAIRO FAMILY MEDICAL CENTER, PC
Entity Type:Organization
Organization Name:CAIRO FAMILY MEDICAL CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:INEZ
Authorized Official - Last Name:WALDEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:229-377-0908
Mailing Address - Street 1:P.O. BOX 541
Mailing Address - Street 2:
Mailing Address - City:CAIRO
Mailing Address - State:GA
Mailing Address - Zip Code:39828
Mailing Address - Country:US
Mailing Address - Phone:229-377-0908
Mailing Address - Fax:229-377-1001
Practice Address - Street 1:91 MLK JR AVE S.W.
Practice Address - Street 2:
Practice Address - City:CAIRO
Practice Address - State:GA
Practice Address - Zip Code:39828
Practice Address - Country:US
Practice Address - Phone:229-377-0908
Practice Address - Fax:229-377-1001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA040814207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000673824BMedicaid
GA000673824BMedicaid
GA08BDKSGMedicare ID - Type Unspecified