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Specialty details in registry · Georgetown, KY

Call (502) 427-6004 Directions

At a glance

808 S Broadway St Ste 12, Georgetown, KY 40324-2300

NPPES record updated Jan 23, 2026. Public records can lag behind changes at a practice.

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  • Are you accepting new patients?
  • Do you accept my specific insurance plan?
  • Do you provide the service I need at this address?
  • Do I need a referral, and what is the earliest appointment?

Insurance participation and appointment availability are not established by these public records.

Practice location

808 S Broadway St Ste 12
Georgetown, KY 40324-2300
Professional details: NPI, taxonomy & registry record
NPI1639059017
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Registry details

Primary taxonomy
Specialty details in registry
Taxonomy code
2251G0304X
Enumeration date
Sep 5, 2025
Record updated
Jan 23, 2026
More registry details
Provider type
Organization · Type 2

Reported taxonomies and licenses

Specialty details in registry

2251G0304X · Primary

License numbers and credentials are reported to NPPES; HCPList does not independently verify them.

Practice location

808 S Broadway St Ste 12
Georgetown, KY 40324-2300
Phone
(502) 427-6004
Fax
(502) 427-0411
Mailing address
808 S BROADWAY ST STE 12

GEORGETOWN, KY 403242300
Source: NPPES Source through Oct 18, 2026An NPI does not verify licensure or credentials.

Information may be outdated or incomplete. Confirm details directly with the practice. HCPList is an independent directory and is not affiliated with CMS.

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