MEDICARE: CLAY COUNTY MEDICAL CENTER, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician		GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	11D0950627	OTHER	GA	CLIA

General Provider Information

NPI Number	:	1508923210
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLAY COUNTY MEDICAL CENTER, PC

Provider Business Mailing Address
First Line	:	PO BOX 281
Second Line	:
City	:	FORT GAINES
State	:	GA
Zip	:	39851-0281
Country	:	US
Telephone Number	:	229-768-3888
Fax Number	:

Provider Business Practice Location Address
First Line	:	305 WASHINGTON ST S
Second Line	:
City	:	FORT GAINES
State	:	GA
Zip	:	39851-4315
Country	:	US
Telephone Number	:	229-768-3888
Fax Number	:	229-768-3889

Authorized Official
Title or Position	:	PRESIDENT
Name	:	KAREN S KINSELL
Credential	:	M.D.
Telephone Number	:	229-768-3888

Provider Enumeration Date	:	01/02/2007
Last Update Date	:	03/01/2018

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