Provider Demographics
NPI:1730533209
Name:GEORGETOWN INTERNAL MEDICINE
Entity type:Organization
Organization Name:GEORGETOWN INTERNAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-863-0722
Mailing Address - Street 1:1138 LEXINGTON RD
Mailing Address - Street 2:SUITE 290
Mailing Address - City:GEORGETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40324-9672
Mailing Address - Country:US
Mailing Address - Phone:502-863-0721
Mailing Address - Fax:502-863-6104
Practice Address - Street 1:200 BEVINS LN STE A
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324-8532
Practice Address - Country:US
Practice Address - Phone:502-863-0722
Practice Address - Fax:502-863-0731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-20
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty