Healthcare Provider Details

I. General information

NPI: 1578273033
Provider Name (Legal Business Name): AUSTIN DALE KINSEY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/24/2022
Last Update Date: 11/24/2022
Certification Date: 11/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

162 HIGHWAY 123
TOCCOA GA
30577-6711
US

IV. Provider business mailing address

162 HIGHWAY 123
TOCCOA GA
30577-6711
US

V. Phone/Fax

Practice location:
  • Phone: 706-716-2796
  • Fax:
Mailing address:
  • Phone: 706-716-2796
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: