Provider Demographics
NPI:1194904284
Name:FAMILY PRACTICE SPECIALIST, PC
Entity type:Organization
Organization Name:FAMILY PRACTICE SPECIALIST, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:D
Authorized Official - Last Name:KISER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-381-2161
Mailing Address - Street 1:203 AVALON AVE
Mailing Address - Street 2:SUITE 350
Mailing Address - City:MUSCLE SHOALS
Mailing Address - State:AL
Mailing Address - Zip Code:35661-2869
Mailing Address - Country:US
Mailing Address - Phone:256-381-2161
Mailing Address - Fax:256-381-2161
Practice Address - Street 1:203 AVALON AVE
Practice Address - Street 2:SUITE 350
Practice Address - City:MUSCLE SHOALS
Practice Address - State:AL
Practice Address - Zip Code:35661-2869
Practice Address - Country:US
Practice Address - Phone:256-381-2161
Practice Address - Fax:256-381-2161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-25
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL10486173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty