MEDICARE: DR. KAREN SUE KINSELL M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	042630	GA
2	2083P0901X	Public Health & General Preventive Medicine Physician	042630	GA
3	208D00000X	General Practice Physician	042630	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	52508388 005	OTHER	GA	BCBS PROVIDER #

General Provider Information

NPI Number	:	1750464855
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KAREN SUE KINSELL M.D.

Provider Business Mailing Address
First Line	:	PO BOX 4207
Second Line	:
City	:	MACON
State	:	GA
Zip	:	31208-4207
Country	:	US
Telephone Number	:	229-768-3888
Fax Number	:	229-768-3889

Provider Business Practice Location Address
First Line	:	305 WASHINGTON ST S
Second Line	:
City	:	FORT GAINES
State	:	GA
Zip	:	39851-4315
Country	:	US
Telephone Number	:	229-768-3888
Fax Number	:	229-768-3889

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/23/2006
Last Update Date	:	09/11/2025

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