CRISP GENERAL INTERNAL MEDICINE INC
Ambulatory Health at 4 Ave, Cordele, GA

License number
Georgia 060593
Category
Ambulatory Health
Type
Medical Specialty
Owner
Name: DR. KEVIN HOLLOWAY M.D.
Title: PRESIDENT
Phone: (229) 273-4989
Address
Address
416 E 4Th Ave STE B, Cordele, GA 31015
National Provider ID: 1669632014
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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CRISP GENERAL INTERNAL MEDICINE, INC

1801 Quail Run, Cordele, GA 31015

Registration:
Apr 9, 2008
State ID:
08029211
Business type:
Domestic Profit Corporation
CEOs:
R. Amber Holloway (Secretary), 1801 Quail Run, Cordele, GA 31015 (Physical),M. Kevin Holloway (CEO), 1801 Quail Run, Cordele, GA 31015 (Physical)
Agent:
Kevin M. Holloway,1801 Quail Run, Cordele, GA (Physical)

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