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General NPI Number Information
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NPI Number | 1932252004
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Entity Type | Organization
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Legal Business Name | CAIRO FAMILY MEDICAL CENTER, PC
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Dates
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Enumeration Date | 01/19/2007
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Last Update Date | 08/19/2008
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Provider Practice Location Address
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Address Line | 91 MLK JR AVE S.W.
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City | CAIRO
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State | GA
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Zip | 39828
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Country | US
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Telephone | 229-377-0908
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Fax | 229-377-1001
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Provider Business Mailing Address
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Address Line | P.O. BOX 541
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City | CAIRO
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State | GA
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Zip | 39828
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Country | US
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Telephone | 229-377-0908
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Fax | 229-377-1001
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Authorized Official
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Title or Position | PRESIDENT & CEO
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Name | DR. LINDA INEZ WALDEN
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Credential | M.D.
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Telephone | 229-377-0908
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 040814
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License Number State | GA
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