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General NPI Number Information
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NPI Number | 1396172334
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Entity Type | Organization
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Legal Business Name | TOWN CENTRAL INSURANCE
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Dates
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Enumeration Date | 10/06/2013
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Last Update Date | 10/06/2013
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Provider Practice Location Address
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Address Line | 748 STONECYPHER ST
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City | CORNELIA
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State | GA
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Zip | 30531-2456
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Country | US
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Telephone | 706-778-6268
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Fax |
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Provider Business Mailing Address
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Address Line | 748 STONECYPHER ST
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City | CORNELIA
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State | GA
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Zip | 30531-2456
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Country | US
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Telephone | 706-778-6268
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Fax |
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Authorized Official
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Title or Position | PRINCIPAL AGENT/ OWNER
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Name | PHAILOTH LOONUBON
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Credential |
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Telephone | 706-778-6268
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251X00000X
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Taxonomy Name | Supports Brokerage Agency
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License Number | 2887248
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License Number State | GA
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