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General NPI Number Information
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NPI Number | 1598828063
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Entity Type | Individual
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Provider Name | RICHARD W. KINSEY D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 12/18/2006
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Last Update Date | 01/07/2016
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Provider Practice Location Address
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Address Line | 6043 PRESTLEY MILL RD SUITE A
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City | DOUGLASVILLE
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State | GA
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Zip | 30134-2280
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Country | US
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Telephone | 770-949-3797
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Fax | 770-949-9077
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Provider Business Mailing Address
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Address Line | 6043 PRESTLEY MILL RD SUITE A
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City | DOUGLASVILLE
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State | GA
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Zip | 30134-2280
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Country | US
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Telephone | 770-949-3797
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Fax | 770-949-9077
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 009063
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License Number State | GA
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