Healthcare Provider Details

I. General information

NPI: 1730533209
Provider Name (Legal Business Name): GEORGETOWN INTERNAL MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2016
Last Update Date: 08/01/2025
Certification Date: 08/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 BEVINS LN STE A
GEORGETOWN KY
40324-8532
US

IV. Provider business mailing address

200 BEVINS LN STE A
GEORGETOWN KY
40324-8532
US

V. Phone/Fax

Practice location:
  • Phone: 502-863-0722
  • Fax: 502-863-0731
Mailing address:
  • Phone: 502-863-0722
  • Fax: 502-863-0731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: PATRICIA A KING
Title or Position: PRACTICE MANAGER
Credential:
Phone: 502-863-0722